Anemik Preterm Bebeklerde Copeptin, Mid-Regional Proadrenomedullin ve N-Terminal Pro-Beyin Natriüretik Peptit Düzeylerinin Değerlendirilmesi: Prospektif Klinik Çalışma

Öz

Yoğun bakım ihtiyacı olan prematüre yenidoğanlar en sık transfüzyon yapılan hasta grupları arasındadır. Literatürde transfüzyon kararını vermekte kullanılan kriterler ve bu kriterlerin sonuçlarını inceleyen çalışmalar olsa da transfüzyon endikasyonları konusunda net bir fikir birliği yoktur. Bu çalışmanın amacı anemik bebeklerde transfüzyon ihtiyacını belirlemede kalp debisindeki değişikliklere duyarlı olan NT-proBNP, copeptin ve MR-proADM düzeylerinin kullanılabilirliğini değerlendirmektir. Yenidoğan yoğun bakım ünitesinde izlenmekte olan ve eritrosit transfüzyonu ihtiyacı olan 24 preterm bebek Transfüzyon grubu ve yenidoğan yoğun bakım ünitesinde izlenen, hematokrit (Hct)>%25 olan ve transfüzyon endikasyonu olabilecek klinik bulgusu olmayan 23 preterm bebek Kontrol Grubuna olarak çalışmaya dahil edildi. Transfüzyon grubunda transfüzyon öncesi ve sonrası copeptin, NT-ProBNP ve MR-proADM düzeyleri arasında fark saptanmadı (p değeri sırasıyla 0,44, 0,64, 0,41). Transfüzyon grubunun transfüzyon öncesi copeptin, NT-proBNP, ve MR-proADM düzeyleri kontrol grubunun düzeyleri ile kıyaslandığında anlamlı fark saptanmadı (sırasıyla p=0,85, 0,75, 0,88). Hemoglobin düzeyi 8 mg/dl altında olan hastalarda copeptin, NT-ProBNP ve MR-proADM düzeyleri Hb düzeyi >8mg/dl iken transfüzyon yapılanlar ve kontrol grubuna göre sayısal olarak yaklaşık 2 kat yüksek bulunmasına rağmen gruplar arasındaki fark istatistiksel olarak anlamlı değildi (p değeri sırasıyla 0,15, 0,47, 0,57). Çalışma grubunun semptomatik, asemptomatik alt gruplarının kontrol grubu ile birlikte olan analizinde copeptin, NT-ProBNP ve MR-proADM düzeyleri açısından fark saptanmadı (p değeri sırasıyla 0,81, 0,99, 0,93). Serolojik belirteçler pek çok durumda yol göstericidir ancak çalışmamızda yer alan Copeptin, NT-proBNP ve MD-proADM’in anemide, transfüzyon kararı vermede kullanışlı olmadığı kanaatine varılmıştır.

Anahtar Kelimeler

• Anemi
• yenidoğan
• eritrosit transfüzyonu
• biyobelirteç

Evaluatıon of Copeptın, Mıd-Regıonal Proadrenomedullın and N-Termınal Pro-Brain Natrıuretıc Peptıt Levels in Anemıc Preterm Babıes: a Prospectıve Clınıcal Study

Öz

Premature newborns in need of intensive care are among the most frequently transfused patient groups. Although there are studies in the literature examining the criteria used to make transfusion decision and the results of these criteria, there is no clear consensus on the indications for transfusion. The aim of this study was to evaluate the usefulness of NT-proBNP, copeptin and MR-proADM levels, which are sensitive to changes in cardiac output, in determining the need for transfusion in anemic infants. Twenty-four preterm infants who were being followed up in the neonatal intensive care unit and needed erythrocyte transfusion were included in the study as the Transfusion group and 23 preterm infants who had haematocrit >25 and no clinical findings indicating transfusion were included in the study as the Control group. No difference was found between pre- and post-transfusion copeptin, NT-ProBNP and MR-proADM levels in the transfusion group (p value 0.44, 0.64, 0.41, respectively). No significant difference was found between the pre-transfusion copeptin, NT-proBNP, and MR-proADM levels of the Transfusion group and the Control group (p=0.85, 0.75, 0.88, respectively). Although copeptin, NT-ProBNP and MR-proADM levels in patients with haemoglobin level below 8 mg/dl were found to be approximately 2-fold higher than those transfused with Hb level >8 mg/dl and the Control group, the difference between the groups was not statistically significant (p value 0.15, 0.47, 0.57, respectively). In the analysis of symptomatic and asymptomatic subgroups of the study group together with the Control group, no difference was found in copeptin, NT-ProBNP and MR-proADM levels (p value 0.81, 0.99, 0.93, respectively). Serological markers are guiding in many cases, but copeptin, NT-proBNP and MD-proADM in our study were not found to be useful in making transfusion decision in anaemia.

Anahtar Kelimeler

• Anemia
• neonatorum
• red cell transfusion
• biomarker

Kaynakça

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