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脓毒症是一种由感染引起的异质性疾病,感染触发了一系列复杂的局部或者全身的免疫炎症反应,引起多器官功能衰竭,发病率和病死率显著升高。由于至今仍然没有诊断脓毒症的金标准,所以脓毒症的临床诊断仍是一个难题。因此,脓毒症的临床诊断需要不断改变来满足临床和研究的要求。然而,尽管有许多新型的生物标记和筛选工具去预测脓毒症发生的风险,但是这些措施的诊断价值和有效性不足以让人满意,并且没有充分的证据去建议临床使用这些新技术。因此,脓毒症的临床诊断标准需要定期更新去适应不断产生的新证据。这篇综述旨在呈现当前脓毒症的诊断和早期识别方面的最新研究证据。临床运用不同的诊断方法的推荐意见依赖于推荐、评价、发展和评估分级体系(Grades of Recommendation Assessment,Development and Evaluation,GRADE),因为大部分的研究是观察性研究,并没有对这些方法进行可靠评估,采用的是两步推理方法。未来需要更多研究来确认或者反驳某一特殊的指标检测,同时应该直接采用相关病人的结果数据。
Sepsis is a heterogeneous disease caused by an infection that triggers a series of complex local or systemic immune inflammatory reactions that cause multiple organ failure with significantly increased morbidity and mortality. As there is still no gold standard for diagnosing sepsis, the clinical diagnosis of sepsis remains a challenge. Therefore, the clinical diagnosis of sepsis needs to be constantly changing to meet clinical and research requirements. However, despite the many new biomarker and screening tools to predict the risk of sepsis, the diagnostic value and effectiveness of these measures are not satisfactory and there is insufficient evidence to recommend clinical use of these new technologies. Therefore, the clinical diagnostic criteria for sepsis need to be regularly updated to accommodate emerging new evidence. This review is intended to present the latest research evidence in the current diagnosis and early identification of sepsis. The recommendations for clinical use of different diagnostic approaches rely on the Grades of Recommendation Assessment, Development and Evaluation (GRADE), as most studies are observational and do not provide reliable Evaluation, using a two-step reasoning method. In the future, more research is needed to confirm or disprove a particular index test, and the results of the relevant patient data should be used directly.