Yoğun Bakım Hastalarında Sarkopeninin Potansiyel Biyobelirteçleri Olarak Miyostatin ve BDNF: Radyolojik ve Biyokimyasal Korelasyon Çalışması

Öz

Amaç: Miyostatin ve Beyin Kaynaklı Nörotrofik Faktör (BKNF), kas metabolizmasında rol oynayan biyomoleküllerdir; ancak kritik hastalarda sarkopeni tespitindeki işlevleri hâlen belirsizdir. Sarkopeni, yoğun bakım ünitesindeki (YBÜ) hastalarda sık görülür ve kötü klinik sonuçlarla ilişkilidir. Bu çalışmanın amacı, serum miyostatin ve BKNF düzeyleri ile radyolojik olarak değerlendirilmiş kas kütlesi ve inflamatuar belirteçler arasındaki ilişkiyi inceleyerek, bu biyobelirteçlerin YBÜ kaynaklı sarkopeni tespitindeki potansiyelini değerlendirmektir. Gereç ve Yöntem: Prospektif olarak tasarlanan çalışmaya, rutin YBÜ bakımı sırasında abdomen bilgisayarlı tomografi (BT) görüntülemesi yapılan 44 yetişkin hasta dâhil edildi. L3 vertebra düzeyinde BT kaynaklı İskelet Kas İndeksi (İMİ) ile iskelet kas kütlesi ölçüldü. Serum miyostatin ve BKNF düzeyleri, rutin kan alımı sırasında elde edilen örneklerden ELISA yöntemi ile belirlendi. Klinik, biyokimyasal ve radyolojik veriler, belirlenmiş İMİ eşik değerlerine göre tanımlanan sarkopeniyle ilişkilendirilerek analiz edildi. Bulgular: Serum BKNF ile miyostatin düzeyleri arasında güçlü bir pozitif korelasyon saptandı (ρ = 0,764, p < 0,001). BKNF; İMİ (ρ = 0,377, p = 0,012), CRP (ρ = 0,302, p = 0,046) ve TNF-alfa (ρ = 0,315, p = 0,037) ile orta düzeyde korelasyon gösterdi. Miyostatin düzeyleri ise İMİ (ρ = 0,464, p = 0,002) ve TNF-alfa (ρ = 0,407, p = 0,006) ile pozitif korelasyon sergiledi; bu sonuçlar hem kas metabolizması hem de sistemik inflamatuar yanıt ile ilişkisini göstermektedir. Sonuç: Çalışmamız, yoğun bakım hastalarında biyokimyasal, radyolojik ve inflamatuar parametreler arasında anlamlı korelasyonlar ortaya koymaktadır. Miyostatin ve BKNF, YBÜ kaynaklı sarkopeniyi tespit etmek için umut vaat eden biyobelirteçler olarak görünmektedir ve erken müdahale stratejilerine rehberlik edebilir. Nörotrofik ve kas düzenleyici faktörler arasındaki etkileşim ile yaşa bağlı kas kaybının BT kanıtı, YBÜ kaynaklı kas atrofisinin patofizyolojisine dair önemli öngörü sunmaktadır ve gelecekteki tedavi yaklaşımlarını yönlendirebilme potansiyeline sahiptir. Anahtar Kelimeler: Sarkopeni, yoğun bakım ünitesi, BKNF, miyostatin, iskelet kas indeksi

Anahtar Kelimeler

• Sarkopeni
• yoğun bakım ünitesi
• BKNF
• miyostatin
• iskelet kas indeksi

Myostatin and BDNF as potential biomarkers of sarcopenia in ICU patients: A radiologic and biochemical correlation study

Öz

Aim: Myostatin (MSTN) and Brain-Derived Neurotrophic Factor (BDNF) are muscle-related biomarkers involved in muscle metabolism, but their roles in detecting sarcopenia in critically ill patients remain unclear. Sarcopenia is common in intensive care unit (ICU) patients and is associated with poor outcomes. This study aimed to investigate the relationship between serum myostatin and BDNF levels and muscle mass assessed by radiologic evaluation, along with inflammatory and clinical severity markers, to evaluate their potential as biomarkers of ICU-acquired sarcopenia. Methods: This prospective study included 44 adult ICU patients at Ankara Etlik City Hospital who underwent abdominal computed tomography (CT) scans. Skeletal muscle mass was assessed at the lomber (L) 3 vertebral level using CT-derived Skeletal Muscle Index (SMI). Serum myostatin and BDNF levels were measured via Enzyme-Linked ImmunoSorbent Assay (ELISA) from blood samples collected during routine ICU care. Clinical, biochemical, and radiologic data were analyzed to assess the relationship between these biomarkers and sarcopenia, defined by established SMI cut-off values. Results: Serum BDNF levels showed a strong positive correlation with myostatin (ρ = 0.764, p < 0.001), and moderate correlations with skeletal muscle index (SMI) (ρ = 0.377, p = 0.012), C-reactive protein (CRP) (ρ = 0.302, p = 0.046), and tumor necrosis factor alpha (TNF-alpha) (ρ = 0.315, p = 0.037). Myostatin levels were positively correlated with SMI (ρ = 0.464, p = 0.002) and TNF-alpha (ρ = 0.407, p = 0.006), suggesting their involvement in both muscle metabolism and systemic inflammatory responses. Conclusion: This study reveals significant correlations between biochemical, radiologic, and muscle-related parameters in critically ill patients. Myostatin and BDNF show promise as biomarkers for detecting ICU-acquired sarcopenia, potentially guiding early intervention strategies. The observed interplay between neurotrophic and muscle-regulating factors, along with CT-based evidence of age-related muscle loss, offers valuable insights into the pathophysiology of ICU-acquired muscle wasting and may guide future therapeutic approaches. Keywords: Sarcopenia, intensive care unit, BDNF, myostatin, skeletal muscle index

Anahtar Kelimeler

• Sarcopenia
• intensive care unit
• BDNF
• myostatin
• skeletal muscle index

Kaynakça

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