M. Werner, U. Otto, D. Schreiter, P. Lamesch, K. Kohlhaw, H. Witzigmann, J. Hauss, M. Fiedler, J. Thiery

The growing knowledge on the pathophysiological role of endotoxin, cytokines and ist regulation by soluble receptors stimulated efforts for a new infectional immunological monitoring for patients at risk on intensive care unit. In critically ill patients after major surgery or trauma with or without severe sepsis and after allogeneic liver and kidney transplantation with a high risk at opportunistic infections we have examined the number of DR+ -monocytes, the levels of endotoxin, procalcitonin, interleukin-6, interleukin-8, tumor necrosis factor and soluble interleukin-2-receptor. This monitoring program provides an objective parameter in determination patients at risk to define the precise clinical outcome in generalized inflammatory process and immunoparalytic defense status. In daily investigations it is possible to define illnes and outcome, the efficacy of therapeutic management like the search and abolition of focus, the steerage of immunosuppression in severe sepsis, antibiotic, antiviral and antimycotic treatment and immunomodulation (GM-CSF, pentaglobin). It is of particular importance, that the demonstrated diagnostic patterns provide information about differentiation between bacterial and fungal infection, to give critically ill patients an early adequate therapy also in absence of microbiological evidence.

Key words: patient at risk, sepsis, transplantatation, immonomonitoring

Dr. Maria Werner

Institut für Laboratoriumsmedizin

Klinische Chemie und Molekulare Diagnostik

Universitätsklinikum Leipzig, AöR

Liebigstr. 27

D-04103 Leipzig

E-mail: mwerner@bitte-keinen-spammedizin.uni-leipzig.de

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