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Medicina de precisión en sepsis: utilidad de los biomarcadores en pacientes biomarcadores en pacientes críticamente enfermos

Precision medicine in sepsis: usefulness of biomarkers In critically ill patientsbiomarkers In critically ill patient




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Molano Franco, D., Gómez Duque, M., Beltrán, E., Villabón González, M., Robayo Valbuena, I. F., Franco, L. F., Cárdenas Colmenares, J. A., Estupiñán Monsalve, Álvaro, Sánchez Vanegas, G., Arévalo Rodriguez, I., & Zamora Romero, J. (2020). Medicina de precisión en sepsis: utilidad de los biomarcadores en pacientes biomarcadores en pacientes críticamente enfermos . Revista Repertorio De Medicina Y Cirugía, 29(2), 75-83. https://doi.org/10.31260/RepertMedCir.01217273.973

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Daniel Molano Franco
    Mario Gómez Duque
      Edgar Beltrán
        Mario Villabón González
          Ivan Felipe Robayo Valbuena
            Luis Felipe Franco
              Jorge Alberto Cárdenas Colmenares
                Álvaro Estupiñán Monsalve
                  Guillermo Sánchez Vanegas
                    Ingrid Arévalo Rodriguez
                      Javier Zamora Romero

                        Daniel Molano Franco,

                        Medicina Crítica y Cuidado Intensivo, Fundación Universitaria de Ciencias de la Salud, Bogotá DC, Colombia.


                        Mario Gómez Duque,

                        Medicina Crítica y Cuidado Intensivo, Fundación Universitaria de Ciencias de la Salud, Bogotá DC, Colombia.


                        Edgar Beltrán,

                        Medicina Crítica y Cuidado Intensivo, Fundación Universitaria de Ciencias de la Salud, Bogotá DC, Colombia.


                        Mario Villabón González,

                        Medicina Crítica y Cuidado Intensivo, Fundación Universitaria de Ciencias de la Salud, Bogotá DC, Colombia.


                        Ivan Felipe Robayo Valbuena,

                        Medicina Crítica y Cuidado Intensivo, Fundación Universitaria de Ciencias de la Salud, Bogotá DC, Colombia.


                        Luis Felipe Franco,

                        Medicina Crítica y Cuidado Intensivo, Fundación Universitaria de Ciencias de la Salud, Bogotá DC, Colombia.


                        Jorge Alberto Cárdenas Colmenares,

                        Medicina Crítica y Cuidado Intensivo, Fundación Universitaria de Ciencias de la Salud, Bogotá DC, Colombia.


                        Álvaro Estupiñán Monsalve,

                        Medicina Crítica y Cuidado Intensivo, Fundación Universitaria de Ciencias de la Salud, Bogotá DC, Colombia.


                        Guillermo Sánchez Vanegas,

                        Epidemiología, División de Investigaciones. Fundación Universitaria de Ciencias de la Salud. Bogotá DC. Colombia.


                        Ingrid Arévalo Rodriguez,

                        Unidad de Bioestadística Clínica, Hospital Universitario Ramón y Cajal - IRYCIS, CIBER de Epidemiologia y Salud Publica, Madrid - España.


                        Javier Zamora Romero,

                        Unidad de Bioestadística Clínica, Hospital Universitario Ramón y Cajal - IRYCIS, CIBER de Epidemiologia y Salud Publica, Madrid - España.


                        Durante años la evolución del cuidado intensivo ha intentado ofrecer una atención basada en protocolos y paquetes de manejo agrupados por patologías y cuadro sindromáticos. Aunque se logró disminuir la mortalidad en diferentes patologías (sepsis y síndromes coronario agudo y de distrés respiratorio agudo), no se han resuelto por completo los problemas clínicos, en especial el diagnóstico y el manejo. Una nueva opción ha surgido en el horizonte denominada “medicina de precisión”, entendida como estrategia de prevención y tratamiento que tiene en cuenta la variabilidad individual. La sepsis es un síndrome con múltiples aristas en cuanto al fenotipo y genotipo, cuyo diagnóstico temprano es relevante para los desenlaces clínicos. Hasta el momento el enfoque principal ha sido la identificación de un germen etiológico para diferenciarla del síndrome de respuesta inflamatoria sistémica (SIRS). En los últimos años el paradigma en enfermedades infecciosas ha cambiado debido a estudios que demuestran como la respuesta inmunitaria del paciente séptico tiene un papel clave en el desarrollo de la enfermedad, con implicaciones en el diagnóstico, pronóstico y tratamiento, que podrían ayudar a cambiar el abordaje en los próximos años gracias a una estrategia basada en medicina de precisión. Hoy los aislamientos microbiológicos y los cultivos siguen siendo el estándar de referencia con varias desventajas como el tiempo para obtener resultados, sobre todo en infecciones por gérmenes resistentes u hongos, que pueden retrasar el inicio de la terapia antimicrobiana. Como alternativa se ha planteado el uso de biomarcadores en sepsis que siendo productos de la respuesta inflamatoria del individuo ante la infección, son útiles para el diagnóstico y pronóstico primordialmente en los críticamente enfermos. Decidimos realizar esta revisión narrativa acerca de la utilidad de los biomarcadores en pacientes con sepsis críticamente enfermos, para enfocarlos en un modelo de medicina personalizada.


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