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BIOMARKERS
Imaging
Twanmoh J.R. et Al. . When overcrowding paralyzes an ED. Manag
Care 2006; 15 ( 6 ): 54-59
From “POC” to “Near to Patient” Blood gases
PRO
PRO
• Higher accuracy and precision
• Well-maintained instruments
• Highly trained laboratory professionals
CONTRA
• Transport delays
Reduce time to appropriate
• Sample queuing decisions making ,fabourably…
• Need to look up the results in the impacting patient outcome…
electronic medical
Global Trends in Point of Care Testing
On market
Prototype
NOT SO FAST……………..
The BIG BOX in the basement
168 assays
vs 1 new
POC Cardio 3
vs Lab Singulex
Peacock WF.
Ann Lab Med 2016;36:405-412
HERE IT COMES: disposable troponin
assay
Differential Diagnosis of SOB
Symptoms of Congestion in AHF
BNP POCT – Studies at ED
• Milestone article on BNP as
biomarker
0.8 -46.3%
-25.9%
0.6
Sensitivity
0.4
0.2
Probability of new cardiovascular
Percent change at 24h events or rehospitalitation
Percent change at discharge
0.0
0.0 0.2 0.4 0.6 0.8 1.0 Di Somma S. et al. Critical Care 2010
1 - Specificity
Cost-Effectiveness of BNP at ED:
The BASEL Study
$8000
$6000
$4000
€1,545 Savings/Patient
$2000
Fabourable effects
Biosite Triage BNP on approprıate rule out
(in pg/mL)
and hospıtal admıssıons and LOS
0
Muller C, et al. N Engl J Med. 2004;350:647-654.
,
67,924 ADHF patients
Mortality rate
Troponin positive cohort:
8.0%
Troponin negative cohort:
2.7%
CONFIDENTIAL
29
Adrenomedullin (ADM)
Key Regulator of the vascular system & Biomarker
of acute vascular dysfunction
hours
Summary of results:
Diagnosis & Prediction of Shock
bio-ADM is an early predictor of shock and vasopressor demand –
supporting early therapy
Monitoring of shock therapy & risk of mortality
The dynamic nature of bio-ADM enables close monitoring of shock patients
1 manuscript in preparation or submitted 2 Caironi et al. CHEST [manuscript accepted]
3 Marino et al. Critical Care 2014, 18:R34.
4 Simon et al. Journal of Critical Care 2016, 38:68-72.
EPOC Application in Septic Patients
Accuracy of POCT for Urinary Infections
Creatinine caveats
Importance of Time in Acute Kidney Injury:
we need AKI biomarkers !
pro-ENK: Majority of patients without kidney failure are within normal range, despite inflammation.
Penkid
What about TBI
• Biomarker physiology
– Is the brain different?
– Can the marker get out?
– Is the timing like the heart?
• Saliva
– Similar to blood
– Lots of WBC
– Lots of bacteria
Spit for TBI
• 500k
proteins on
1 chip
Microarray technology