Araştırma Makalesi
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Neonatal Sepsis Şüphesi Olan Yenidoğanlarda Akut Faz Reaktanı Olarak C Reaktif Protein, Prokalsitonin, İnterlökin-18 Düzeylerinin Değerlendirilmesi

Yıl 2022, Cilt: 17 Sayı: 2, 46 - 52, 15.07.2022
https://doi.org/10.17517/ksutfd.879147

Öz

Amaç: Neonatal sepsis yaşamın ilk ayında sistemik infeksiyon bulguları ve bakteriyemiyle nitelenen klinik bir sendromdur. Neonatal sepsis neonatal mortalite ve morbiditenin önemli bir nedenidir ve doğru teşhisi için klinik ve laboratuvar bulguların bir kombinasyonu gereklidir. Bu çalışma neonatal sepsisin erken
tanı ve takibinde C reaktif protein (CRP), prokalsitonin (PCT) ve İnterlökin-18 (IL-18) düzeylerinin incelenmesi ve karşılaştırılması amacıyla planlanmıştır.
Gereç ve Yöntemler: Çalışmaya toplam 103 olgu dahil edildi. Elli beş olgu klinik belirti ve bulgularıyla sepsis grubunu oluşturken, sepsis belirti ve bulgularını taşımayan 48 olgu kontrol grubu olarak çalışmaya dahil edildi. Hastaların demografik özellikleri, prenatal ve maternal özellikleri kaydedildi. Hematolojik
bulguları, CRP, PCT ve IL-18 düzeyleri ölçüldü.
Bulgular: C reaktif protein (CRP) (53.42±61.94 vs 3.2±0.53 mg/dl, p<0.001), PCT (11.53±18.68 vs 0.44±0.66 ng/ml, p<0.001) ve IL-18 (18.62±15.64 vs 13.00±11.83 ng/L) düzeyleri sepsis grubunda kontrol grubuna kıyasla istatistiksel olarak anlamlı yüksek bulundu. ROC eğrisi analizi sonuçlarına göre CRP, PCT ve IL-18 neonatal sepsis tanı ve takibi için anlamlı parametreler olarak saptandı (p<0.05). 0. saatte IL-18 için eşik değer 11.35 ng/L (duyarlılık %63.6, özgüllük %68.7, AUC: 0.627, p=0.027) ve 24. saatte IL-18 için eşik değer 12,56 ng/L (duyarlılık %63.6, özgüllük %70.8, AUC: 0.662, p=0.005) idi.
Sonuç: Duyarlılık ve özgüllüğü CRP ve PCT’den düşük olmasına rağmen; IL-18 neonatal sepsis tanı ve takibine katkıda bulunan yardımcı veri olarak kabul edilebilir.

Destekleyen Kurum

KSÜ Bilimsel Araştırma Projeleri (BAP)

Proje Numarası

2017/2-44D

Kaynakça

  • Stefanovic IM. Neonatal sepsis. Biochemia Medica 2011;21(3):276–281.
  • Machado JR, Soave DF, da Silva MV, de Menezes LB, Etchebehere RM, Monteiro ML et al. Neonatal sepsis and inflammatory mediators. Mediators Inflamm 2014;2014:269681.
  • Zea-Vera A, Ochoa TJ. Challenges in the diagnosis and management of neonatal sepsis. J Trop Pediatr 2015;61(1):1–13.
  • Shah BA, Padbury JF. Neonatal sepsis: an old problem with new insights. Virulence 2014;5(1):170–178.
  • Camacho-Gonzalez A, Spearman PW, Stoll BJ. Neonatal infectious diseases: evaluation of neonatal sepsis. Pediatr Clin North Am 2013;60 (2):367–389.
  • Kingsmore SF, Kennedy N, Halliday HL. Identification of diagnostic biomarkers for infection in premature neonates. Mol Cell Proteomics 2008;7(10):1863–1875.
  • Dinarello CA, Novick D, Kim S, Kaplanski G. Interleukin-18 and IL-18 binding protein. Front Immunol 2013;4:289.
  • Cortese F, Scicchitano P, Gesualdo M, Filaninno A, De Giorgi E, Schettini F et al. Early and late infections in newborns: Where do we stand? A review. Pediatrics Neonatol 2016;57(4):265–273.
  • Kanai T, Watanabe M, Okazawa A, Nakamaru K, Okamoto M, Naganuma M et al. Interleukin 18 is a potent proliferative factor for intestinal mucosal lymphocytes in Crohn’s disease. Gastroenterology 2000;119(6):1514–1523.
  • Halpern MD, Khailova L, Molla-Hosseini D, Arganbright K, Reynolds C, Yajima M et al. Decreased development of necrotizing enterocolitis in il-18-deficient mice. Am J Physiol Gastrointest Liver Physiol 2008;294 (1):20–26.
  • Grobmyer SR, Lin E, Lowry SF, Rivadeneira DE, Potter S, Barie PS et al. Elevation of IL-18 in human sepsis. J Clin Immunol 2000;20(3):212–215.
  • Endo S, Inada K, Yamada Y, Wakabayashi G, Ishikura H, Tanaka T et al. Interleukin 18 (IL-18) levels in patients with sepsis. Journal of Medicine 2000;31(1-2):15-20.
  • Eidt MV, Nunes FB, Pedrazza L, Caeran G, Pellegrin G, Melo DAS et al. Biochemical and inflammatory aspects in patients with severe sepsis and septic shock: The predictive role of IL-18 in mortality. Clin Chim Acta 2016;453:100–106.
  • Cui YL, Wang B, Gao HM, Xing YH, Li J, Li HJ et al. Interleukin- 18 and miR-130a in severe sepsis patients with thrombocytopenia. Patient Prefer Adherence 2016;10:313–319.
  • Tschoeke SK, Oberholzer A, Moldawer LL. Interleukin-18: A novel prognostic cytokine in bacteria-induced sepsis. Crit Care Med 2006;34(4):1225-1233.
  • Mierzchala-Pasierb M, Krzystek-Korpacka M, Lesnik P, Adamik B, Placzkowska S, Serek P et al. Interleukin-18 serum levels in sepsis: Correlation with disease severity and inflammatory markers. Cytokine 2019;120:22–27.
  • Bender J, Thaarup J, Varming K, Krarup H, Ellermann-Eriksen S, Ebbesen F. Early and late markers for the detection of early-onset neonatal sepsis. Dan Med Bull 2008;55(4):219–223.
  • Sood BG, Shankaran S, Schelonka RL, Saha S, Benjamin DK, Jr, Sánchez PJ et al. Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Cytokine profiles of preterm neonates with fungal and bacterial sepsis. Pediatr Res 2012;72(2):212–220.
  • Zasada M, Lenart M, Rutkowska-Zapala M, Stec M, Mol N, Czyz O et al. Analysis of selected aspects of inflammasome function in the monocytes from neonates born extremely and very prematurely. Immunobiology 2018;223(1):18–24.
  • Wynn JL, Wilson CS, Hawiger J, Scumpia PO, Marshall AF, Liu JH, et al. Targeting IL- 17A attenuates neonatal sepsis mortality induced by IL-18. Proc Natl Acad Sci USA. 2016;113(19):2627– 2635.

Evaluation of CRP, Procalcitonin, Interleukin-18 Levels as Acute Phase Reactants in Newborns with Suspected Neonatal Sepsis

Yıl 2022, Cilt: 17 Sayı: 2, 46 - 52, 15.07.2022
https://doi.org/10.17517/ksutfd.879147

Öz

Objective: Neonatal sepsis is a clinical syndrome characterized by signs of systemic infection and bacteremia in the first month of life. Neonatal sepsis is an important cause of neonatal mortality and morbidity, and a combination of clinical and laboratory findings is required for the correct diagnosis of neonatal sepsis. This study was planned to examine and compare C reactive protein (CRP), procalcitonin (PCT) and Interleukin-18 (IL-18) levels in the early diagnosis and follow-up of neonatal sepsis.
Material and Methods: A total of 103 cases were included in the study. While 55 cases with the clinical signs and symptoms were in the sepsis group, 48 cases without the signs and symptoms of sepsis were included in the study as the control group. Demographic characteristics, prenatal and maternal characteristics of the patients were recorded. Hematological findings, CRP, PCT and IL-18 levels were measured.
Results: C reactive protein (CRP) (53.42±61.94 vs 3.2±0.53 mg/dl, p<0.001), PCT (11.53±18.68 vs 0.44±0.66 ng/ml, p <0.001) and IL-18 (18.62±15.64 vs 13.00±11.83 ng/L) levels were found to be statistically significantly higher in the sepsis group compared to the control group. According to the results of ROC curve analysis, CRP, PCT and IL-18 were found to be significant parameters for the diagnosis and follow-up of neonatal sepsis (p<0.05). The cut-off value for IL-18 at 0 h was 11.35 ng/L (sensitivity 63.6%, specificity 68.7%, AUC:0.627, p=0.027) and the cut-off value for IL-18 at 24 h was 12.56 ng/L (sensitivity 63.6%, specificity 70.8%, AUC:0.662, p=0.005).
Conclusion: Although sensitivity and specificity are lower than CRP and PCT; IL-18 can be considered as helpful data contributing to the diagnosis and follow-up of neonatal sepsis.

Proje Numarası

2017/2-44D

Kaynakça

  • Stefanovic IM. Neonatal sepsis. Biochemia Medica 2011;21(3):276–281.
  • Machado JR, Soave DF, da Silva MV, de Menezes LB, Etchebehere RM, Monteiro ML et al. Neonatal sepsis and inflammatory mediators. Mediators Inflamm 2014;2014:269681.
  • Zea-Vera A, Ochoa TJ. Challenges in the diagnosis and management of neonatal sepsis. J Trop Pediatr 2015;61(1):1–13.
  • Shah BA, Padbury JF. Neonatal sepsis: an old problem with new insights. Virulence 2014;5(1):170–178.
  • Camacho-Gonzalez A, Spearman PW, Stoll BJ. Neonatal infectious diseases: evaluation of neonatal sepsis. Pediatr Clin North Am 2013;60 (2):367–389.
  • Kingsmore SF, Kennedy N, Halliday HL. Identification of diagnostic biomarkers for infection in premature neonates. Mol Cell Proteomics 2008;7(10):1863–1875.
  • Dinarello CA, Novick D, Kim S, Kaplanski G. Interleukin-18 and IL-18 binding protein. Front Immunol 2013;4:289.
  • Cortese F, Scicchitano P, Gesualdo M, Filaninno A, De Giorgi E, Schettini F et al. Early and late infections in newborns: Where do we stand? A review. Pediatrics Neonatol 2016;57(4):265–273.
  • Kanai T, Watanabe M, Okazawa A, Nakamaru K, Okamoto M, Naganuma M et al. Interleukin 18 is a potent proliferative factor for intestinal mucosal lymphocytes in Crohn’s disease. Gastroenterology 2000;119(6):1514–1523.
  • Halpern MD, Khailova L, Molla-Hosseini D, Arganbright K, Reynolds C, Yajima M et al. Decreased development of necrotizing enterocolitis in il-18-deficient mice. Am J Physiol Gastrointest Liver Physiol 2008;294 (1):20–26.
  • Grobmyer SR, Lin E, Lowry SF, Rivadeneira DE, Potter S, Barie PS et al. Elevation of IL-18 in human sepsis. J Clin Immunol 2000;20(3):212–215.
  • Endo S, Inada K, Yamada Y, Wakabayashi G, Ishikura H, Tanaka T et al. Interleukin 18 (IL-18) levels in patients with sepsis. Journal of Medicine 2000;31(1-2):15-20.
  • Eidt MV, Nunes FB, Pedrazza L, Caeran G, Pellegrin G, Melo DAS et al. Biochemical and inflammatory aspects in patients with severe sepsis and septic shock: The predictive role of IL-18 in mortality. Clin Chim Acta 2016;453:100–106.
  • Cui YL, Wang B, Gao HM, Xing YH, Li J, Li HJ et al. Interleukin- 18 and miR-130a in severe sepsis patients with thrombocytopenia. Patient Prefer Adherence 2016;10:313–319.
  • Tschoeke SK, Oberholzer A, Moldawer LL. Interleukin-18: A novel prognostic cytokine in bacteria-induced sepsis. Crit Care Med 2006;34(4):1225-1233.
  • Mierzchala-Pasierb M, Krzystek-Korpacka M, Lesnik P, Adamik B, Placzkowska S, Serek P et al. Interleukin-18 serum levels in sepsis: Correlation with disease severity and inflammatory markers. Cytokine 2019;120:22–27.
  • Bender J, Thaarup J, Varming K, Krarup H, Ellermann-Eriksen S, Ebbesen F. Early and late markers for the detection of early-onset neonatal sepsis. Dan Med Bull 2008;55(4):219–223.
  • Sood BG, Shankaran S, Schelonka RL, Saha S, Benjamin DK, Jr, Sánchez PJ et al. Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Cytokine profiles of preterm neonates with fungal and bacterial sepsis. Pediatr Res 2012;72(2):212–220.
  • Zasada M, Lenart M, Rutkowska-Zapala M, Stec M, Mol N, Czyz O et al. Analysis of selected aspects of inflammasome function in the monocytes from neonates born extremely and very prematurely. Immunobiology 2018;223(1):18–24.
  • Wynn JL, Wilson CS, Hawiger J, Scumpia PO, Marshall AF, Liu JH, et al. Targeting IL- 17A attenuates neonatal sepsis mortality induced by IL-18. Proc Natl Acad Sci USA. 2016;113(19):2627– 2635.
Toplam 20 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Sağlık Kurumları Yönetimi
Bölüm Araştırma Makaleleri
Yazarlar

Büşra Seğmen Bu kişi benim 0000-0002-5725-9131

Sadık Yurttutan 0000-0002-4994-9124

Nurten Seringeç Akkeçeci 0000-0003-1915-2330

Fatma İnanç Tolun 0000-0002-1157-2958

Aydın Bozkaya Bu kişi benim 0000-0001-8800-2753

Proje Numarası 2017/2-44D
Erken Görünüm Tarihi 11 Temmuz 2022
Yayımlanma Tarihi 15 Temmuz 2022
Gönderilme Tarihi 12 Şubat 2021
Kabul Tarihi 10 Mart 2021
Yayımlandığı Sayı Yıl 2022 Cilt: 17 Sayı: 2

Kaynak Göster

AMA Seğmen B, Yurttutan S, Seringeç Akkeçeci N, İnanç Tolun F, Bozkaya A. Neonatal Sepsis Şüphesi Olan Yenidoğanlarda Akut Faz Reaktanı Olarak C Reaktif Protein, Prokalsitonin, İnterlökin-18 Düzeylerinin Değerlendirilmesi. KSÜ Tıp Fak Der. Temmuz 2022;17(2):46-52. doi:10.17517/ksutfd.879147