Yenidoğanlarda sepsis ajanlarının erken saptanmasında trombosit indekslerinin rolü

Year 2024, Volume: 49 Issue: 3, 807 - 817, 30.09.2024

Adnan Barutçu , Ferda Özlü , Hacer Yapıcıoğlu , İlker Ünal

https://doi.org/10.17826/cumj.1503225

Abstract

Amaç: Yenidoğan sepsisi, morbidite ve mortalitenin önemli bir nedenidir. Yenidoğan sepsisinin belirtileri ve semptomları spesifik olmayıp, tanı için ideal bir belirteç bulunmamaktadır. Çalışmamız, sepsis ajanlarını belirlemede trombosit indekslerinin rolünü araştırmayı amaçlamaktadır.
Gereç ve Yöntem: Sepsis tanısı olan toplam 90 hastanın kaydı retrospektif olarak incelenerek gram-pozitif, gram- negative ve Candida enfeksiyonu olan hastaların demografik ve klinik özellikleri karşılaştırıldı ve hastaların tanı anındaki ve enfeksiyonun beşinci günündeki tam kan sayımları değerlendirilerek, platelet sayıları (PLT), ortalama platelet hacmi (MPV), plateletkrit (PCT) ve dağılım genişliği (PDW) değerleri ROC eğrisi analizi ile karşılaştırıldı.
Bulgular: Cinsiyet, gestasyonel hafta, doğum ağırlığı, surfaktan kullanımı, mekanik ventilatör tedavisi gereksinimi ve nekrotizan enterokolit açısından gruplar arasında istatistiksel fark bulunamadı. İlk tespit edildiğinde, gram-pozitif bakteriyel enfeksiyonları tespit etmede PCT, PLT ve MPV (trombositopenisiz) değerlerinin ROC eğri-altı alan (AUC)'si sırasıyla 0,764, 0,765 ve 0,792 olarak bulundu.
Sonuç: İlk tanı anında PCT ve PLT değerlerindeki artış, gram-pozitif bakteriyel enfeksiyonları tanımak için kullanılabilir. MPV'de azalma ise trombositopeni görülmeyen mantar enfeksiyonları için erken tanı amaçlı kullanılabilir.

Keywords

Yenidoğan, sepsis, ortalama platelet hacmi (MPV), plateletkrit (PCT), platelet (PLT)

The role of thrombocyte indices in early determination of sepsis agents in newborns

Abstract

Purpose: Neonatal sepsis is an important cause of morbidity and mortality. The signs and symptoms of neonatal sepsis are nonspecific, and there is no ideal marker for diagnosis. Our study aimed to investigate the role of platelet indices in determining agents in sepsis.
Materials and Methods: A total of 90 records with sepsis data were examined retrospectively, demographic and clinical characteristics of gram-positive, gram-negative and Candida infection patients were evaluated by complete blood counts at the time of diagnosis and on the fifth day of infection and platelet amount (PLT), mean platelet volume (MPV), plateletcrit (PCT) and distribution width (PDW) values were compared by ROC curve analysis.
Results: No statistical difference was found between the groups in terms of gender, gestational week, birth weight, surfactant use, need for mechanical ventilator treatment, and necrotizing enterocolitis. When infection was first detected, the Area Under Curve (AUC) of PCT, PLT and MPV (without thrombocytopenia) values in detecting gram-positive bacterial infection were 0.764, 0.765 and 0.792 respectively.
Conclusion: The increase in PCT and PLT values at the time of initial diagnosis can be used to detect gram-positive bacterial infections. A decrease in MPV can be used for early diagnosis of fungal infections without thrombocytopenia.

Keywords

Neonatal, Sepsis, Mean Platelet Volume (MPV), Plateletcrit(PCT), Platelet(PLT)

References

• Raimondi F, Ferrara T, Maffucci R, Milite P, Del Buono D, Santoro P et al. Neonatal sepsis: a difficult diagnostic challenge. Clin Biochem. 2011;44:463-4.
• Satar M, Arısoy AE, Çelik İH. Turkish Neonatal Society guideline on neonatal infections - diagnosis and treatment. Turk Arch Pedıatr. 2018;53:88-100.
• Jyothi P, Basavaraj MC, Basavaraj PV. Bacteriological profile of neonatal septicemia and antibiotic susceptibility pattern of the isolates. J Nat Sci Biol Med. 2013;4:306-9.
• Guida JD, Kunig AM, Leef KH, McKenzie SE, Paul DA. Platelet count and sepsis in very low birth weight neonates: is there an organism-specific response? Pediatrics. 2003;111:1411-5.
• Gao Y, Li Y, Yu X, Guo S, Ji X, Sun T et al. The impact of various platelet indices as prognostic markers of septic shock. PLoS One. 2014;9:e103761.
• Kitazawa T, Yoshino Y, Tatsuno K, Ota Y, Yotsuyanagi H. Changes in the mean platelet volume levels after bloodstream infection have prognostic value. Intern Med. 2013;52:1487-93.
• Solmaz A, Guzelcicek A. Çocuk yoğun bakım ünitesinde izlenen sepsis olgularının geriye dönük analizi. Harran Üniversitesi Tıp Fakültesi Dergisi. 2019;16:24-8.
• Ershad M, Mostafa A, Dela Cruz M, Vearrier D. Neonatal sepsis. Curr Emerg Hosp Med Rep. 2019;7:83-90.
• Arabdin M, Khan A, Zia S, Khan S, Khan GS, Shahid M. Frequency and severity of thrombocytopenia in neonatal sepsis. Cureus. 2022;14:e22665.
• Tayman C, Tonbul A, Akca H, Bilici M. Mean platelet volume may simply predict the severity of sepsis in preterm infants. Clin Lab. 2014;60:1193-200.
• Sarkhiz SG, Kilinc MY, Uygun SS, Konak M, Soylu H. Could plateletcrit, in the fırst 24 hours of lıfe, be an early indıcator of poor etıology and prognosıs in preterm infants? Pediatric Practice and Research. 2019;7:176-81.
• Shaaban HA, Safwat N. Mean platelet volume in preterm: a predictor of early onset neonatal sepsis. J Matern Fetal Neonatal Med. 2020;33:206-11.
• Catal F, Tayman C, Tonbul A, Akça H, Kara S, Tatli MM et al. Mean platelet volume may simply predict the severity of sepsis in preterm infants. Clin Lab. 2014;60:1193-200.
• Vardon-Bounes F, Ruiz S, Gratacap MP, Garcia C, Payrastre B, Minville V. Platelets are critical key players in sepsis. Int J Mol Sci. 2019;20:3494.
• Eberl C, Speth C, Jacobsen ID, Hermann M, Hagleitner M, Deshmukh H et al. Candida: platelet interaction and platelet activity in vitro. J Innate Immun. 2019;11:52-62.
• Majumdar A, Biswas S, Jana A. Platelet indices as an earlier and economical marker of neonatal sepsis. Iraqi Journal of Hematology. 2021;10:108-11.
• Wang H, Naghavi M, Allen C, Barber RM, Bhutta ZA, Carter A et al. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388:1459-544.
• Li J, Xia S, Liu Y, Zhang S, Jin Z. Bacteriological profile and antibiotic susceptibility pattern of neonatal septicemia and associated factors of ICU hospitalization days. Infect Drug Resist. 2022;15:427.
• Dong H, Cao H, Zheng H. Pathogenic bacteria distributions and drug resistance analysis in 96 cases of neonatal sepsis. BMC Pediatr. 2017;17:44.
• Sharma CM, Agrawal RP, Sharan H, Kumar B, Sharma D, Bhatia SS. “Neonatal sepsis”: bacteria & their susceptibility pattern towards antibiotics in neonatal intensive care unit. J Clin Diagn Res. 2013;7:2511.
• Moges F, Eshetie S, Yeshitela B, Abate E. Bacterial etiologic agents causing neonatal sepsis and associated risk factors in Gondar, Northwest Ethiopia. BMC Pediatr. 2017;17:137.
• Muller-Pebody B, Johnson AP, Heath PT, Gilbert RE, Henderson KL, Sharland M et al. Empirical treatment of neonatal sepsis: are the current guidelines adequate? Arch Dis Child Fetal Neonatal Ed. 2011;96:F4-8.
• Mishra S, Jaiswar S, Saad S, Tripathi S, Singh N, Deo S et al. Platelet indices as a predictive marker in neonatal sepsis and respiratory distress in preterm prelabor rupture of membranes. Int J Hematol. 2021;113:199-206.