Yoğun Bakımda Takip Edilen Entübe Hastalarda Bronşial Aspirasyon Sıvında NGAL ve KIM-1 Varlığının Mortalite Üzerine Etkisi

Amaç: Akut böbrek yetersizliği sepsisde en sık görülen komplikasyonlardan biridir ve mortalite nedenlerindendir. Böbrek hasarının erken göstergelerinden olan nötrofil jelatinaz ilişkili lipokalin (NGAL) ve böbrek hasarı molekül-1 (KIM-1) proteinlerinin akciğer sıvılarında izlenmesinin sepsiste mortalite gelişimini erken dönemde öngörebileceği düşünülmektedir. Bu çalışmada; alveolar nötrofillerde NGAL ve KIM-1 varlığı ile sepsiste böbrek hasarına bağlı mortalite arasındaki ilişki araştırılmıştır. Gereç ve Yöntemler: Takibini yaptığımız Covid-19 olmayan hastalardan alınan trakeal aspirasyon sıvısına hücre bloklaması yapılmış ve immunohistokimyasal boyama ile boyanmıştır. Bulgular: Çalışmaya toplam 56 hasta alınmıştır. Hastaların yaş ortalaması 70,13±13 yıl, yoğun bakımda ortalama takip süresi 27.5±18.3 gündür. Hastaların 19’unda (%33.9) makrofajlarda veya nötrofillerde NGAL proteini saptandı. NGAL ekspresyonunun varlığı ile cinsiyet (p=0,931), sepsis varlığı (p=0,293) ve sağ kalım arasında istatistiksel olarak anlamlı bir ilişki saptanmadı (p=0,134). Trakeal aspirasyon örneğinde %3’ün üzerinde şiddetli yangı hücresi varlığı olan şiddetli sepsisteki hastalar incelendiğinde (n=39), NGAL ekspresyonunun varlığı ile cinsiyet (p=0,250), sepsis varlığı (p=0,206) ve sağ kalım (p=0,151) arasında istatistiksel olarak anlamlı bir ilişki bulunamadı. KIM-1 ekspresyonu sadece 2 olgunun materyalindeki epitel hücrelerinde soluk pozitif olup, istatistiksel anlamlılık yoktu. Sonuç: Sepsis, yoğun bakım ünitelerinde sık karşılaşılan ölüm nedenlerinden olup, çoklu organ yetersizliğine gidebilen sistemik komplikasyonlara yol açar. Akut böbrek yetersizliği en sık görülen komplikasyonlardan biridir ve mortalite nedenlerindendir. Böbrek hasarının erken göstergelerinden olan NGAL ve KIM-1 proteinlerinin akciğer sıvılarında izlenmesinin mortalite hakkında fikir verebileceğini düşünsek de muhtemelen olgu sayısının azlığı nedeniyle çalışmamızda anlamlı istatistiksel ilişki saptayamadık. Sorguladığımız ilişkinin geniş serilerde araştırılmasının önemli olduğunu düşünüyoruz.

Anahtar Kelimeler:

yoğun bakım, biyobelirteç, mortalite, sepsis

The effect of the presence of NGAL and KIM-1 in the bronchial aspiration fluid on mortality in intubated patients followed in the intensive care unit

Aim: Sepsis continues to be an important cause of mortality and morbidity in intensive care units. Therefore, it is important to predict the development of mortality in sepsis at an early stage. The search for prognostic markers that can be used to predict mortality in intensive care follow-up is still ongoing. This study was conducted to examine the effect of the presence of NGAL and KIM-1 in alveolar neutrophils on mortality. Material and methods: Cell blocking was performed on bronchoalveolar lavage (BAL) fluid taken from 56 non-Covid-19 sepsis patients we followed up and stained with immunohistochemical staining. Results: The mean age of the patients was 70.13±13, and the mean follow-up period in the intensive care unit was 27.5±18.3 days. NGAL protein was detected in macrophages or neutrophils in 19 (33.9%) patients. In chi-square analysis, no statistically significant correlation was found between the presence of NGAL expression and gender (p=0.931), the presence of sepsis (p=0.293), and survival (p=0.134). When patients with severe sepsis with more than 3% PNL cells in the BAL sample were analyzed (only 39 patients), there was no statistical difference between the presence of NGAL expression and gender (p=0.250), presence of sepsis (p=0.206) and survival (p=0.151). No significant relationship was found. KIM-1 expression was faintly positive in epithelial cells in the material of only 2 cases, and there was no statistical significance. Conclusion: Sepsis is a common cause of death in intensive care units and causes systemic complications that can lead to multi-organ failure. Acute renal failure (ARF) is one of the most common complications and a cause of mortality. Although we think that monitoring of NGAL and KIM-1 proteins, which are early indicators of kidney damage, in lung fluids may give us an idea about mortality, we could not detect a significant statistical relationship in our study, probably due to the small number of cases. We think it is essential to investigate the relationship we question in large series.

Keywords:

critical care, NGAL, KIM-1 mortality, sepsis, sepsis, sepsis,

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