Dilek ULUBAS, Ayşen Sumru KAVURT, Ozge AYDEMİR, Ahmet Yağmur BAŞ, Nihal DEMİREL

Neonatal sepsis ve septik şokta serum iskemi modifiye albümin düzeyleri

Amaç: Yenidoğan sepsisi en sık görülen morbidite ve mortalite nedenidir. Serum iskemi modifiye albümin (IMA), iskemik durumlar için spesifik ve hassas bir belirteçtir. Bu çalışmada yenidoğan sepsisinde IMA düzeylerini ve hastalık şiddeti ile ilişkisini araştırmayı amaçladık.Gereç ve Yöntem: Mart 2012 ile Aralık 2012 tarihleri arasında üçüncü basamak yenidoğan yoğun bakım ünitesinde (NICU) prospektif kontrollü bir çalışma yapılmıştır. Postnatal 28 günden küçük sepsis tanısı alan bebekler çalışmaya dahil edildi. Sepsis tanısında kan kültürü, C-reaktif protein (CRP) tam kan sayımı ve periferik yayma ile birlikte serum İMA düzeylerine bakıldı. Klinik veriler, bebekler için klinik risk indeksi (CRIB) ve pediyatrik lojistik organ disfonksiyon skoru (PELOD), septik şok ve prognoz kaydedildi.Bulgular: Çalışmaya 39 hasta ve 22 sağlıklı kontrol dahil edildi. Hastaların ortalama gebelik haftası ve doğum ağırlığı sırasıyla 30.1 ± 4.2 hafta ve 1257 ± 474 gramdı. Hastalarda serum IMA düzeyleri kontrollere göre anlamlı olarak yüksekti (p=0.04). Septik şok tanısı alan hastalarda (n=8) serum IMA düzeyleri şok olmayan hastalara göre daha yüksekti (n =31), ancak fark istatistiksel olarak anlamlı değildi (p=0.348). Serum İMA düzeyleri, beyaz hücre sayısı (p=0.008, rho=0.419), mutlak nötrofil sayısı (p=0.006, rho=0.429) ve CRIB skoru (p=0.008, rho=0.337) ile korelasyon gösterdi.Sonuç: Sepsisli yenidoğanlarda serum İMA düzeyleri anlamlı olarak yüksek bulundu. Bununla birlikte, septik şoku olan ve olmayan yenidoğanlar arasında anlamlı bir fark yoktu. Serum İMA düzeyleri yenidoğan sepsis tanısında yararlı olabilir. Hastalığın şiddetini tahmin etmede kullanılabilmesi için sepsis tanısı olan daha çok sayıda yenidoğanda yapılan çalışmalara ihtiyaç vardır.

Anahtar Kelimeler:

İskemi modifiye albümin, yenidoğan, sepsis

Serum ischemia-modified albumin levels in neonatal sepsis and septic shock.

Aim: Neonatal sepsis is the most common cause of morbidity and mortality. Serum ischemia modified albumin (IMA) is a specific and sensitive marker for ischemic conditions. We aimed to investigate IMA levels in neonatal sepsis and its relation to disease severity.Material and Method: A prospective controlled study was conducted in a tertiary neonatal intensive care unit (NICU) between March 2012 and December 2012. Neonates diagnosed with sepsis younger than 28 days’ postnatal age were enrolled. Serum IMA levels with blood culture, C- reactive protein (CRP) complete blood count, and peripheral smear were obtained at the time of diagnosis. Clinical data, clinical risk index for babies (CRIB), and pediatric logistic organ dysfunction score (PELOD), septic shock, and prognosis were recorded.Results: 39 patients and 22 healthy controls were enrolled. Mean gestational age (GA) and birth weight (BW) of patients were 30.1 ± 4.2 weeks and 1257 ± 474 g, respectively. Serum IMA levels were significantly higher in patients compared to controls (p=0.04). Serum IMA levels were higher in patients with septic shock (n=8) compared to patients without shock (n=31), but the difference was not statistically significant (p=0.348). Serum IMA levels were correlated CRIB score (p=0.008, rho=0.337), white blood count (WBC) (p=0.008, rho=0.419) and absolute neutrophil count (ANC) (p=0.006, rho=0.429). Conclusion: Serum IMA levels were significantly higher in septic neonates. However, there was no significant difference between neonates with septic shock and without shock. Serum IMA levels may be useful in neonatal sepsis at the time of diagnosis. Further studies are needed for predicting disease severity in a larger group of septic neonates.

Keywords:

Ischemia modified albumin, newborn, sepsis,

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Ethan G. Leonard, Katherine Dobbs. Postnatal Bacterial İnfections. In: Martin RJ, Fanaroff AA, Walsh MC, editors. Fanaroff and Martin’s neonatal-perinatal medicine: diseases of the fetus and infant. 10th ed. St. Louis (MO): Elsevier Mosby; 2015. 734-750.
Bizzarro MJ, Raskind C, Baltimore RS, Gallagher PG. Seventy-five years of neonatal sepsis at Yale: 1928-2003. Pediatrics. 2005 Sep; 116(3):595-602.
Stoll BJ, Hansen NI, Sánchez PJ, Faix RG, Poindexter BB, Van Meurs KP, et al. National Institute of Child Health and Human Development Neonatal Research Network. Early onset neonatal sepsis: the burden of group B Streptococcal and E. coli disease continues. Pediatrics. 2011 Jan; 127(1):62-70.
Kermorvant-Duchemin E, Laborie S, Rabilloud M, Lapillonne A, Claris O. Outcome and prognostic factors in neonates with septic shock. Pediatr Crit Care Med. 2008 Mar;9(2):186-91.
Nguyen HB, Rivers EP, Abrahamian FM, Moran GJ, Abraham E, Trzeciak Set et al. Severe sepsis and septic shock: review of the literature and emergency department management guidelines. Ann Emerg Med. 2006 Jul;48(1):28-54.
Dominguez-Rodriguez A, Abreu-Gonzalez P. Current role of ischemia-modified albumin in routine clinical practice. Biomarkers. 2010 Dec;15(8):655-62
Sinha MK, Roy D, Gaze DC, Collinson PO, Kaski JC. Role of "Ischemia modified albumin", a new biochemical marker of myocardial ischaemia, in the early diagnosis of acute coronary syndromes. Emerg Med J. 2004 Jan;21(1):29-34.
Kaefer M, Piva SJ, De Carvalho JA, Da Silva DB, Becker AM, Coelho AC, et al. Association between ischemia modified albumin, inflammation and hyperglycemia in type 2 diabetes mellitus. Clin Biochem. 2010 Mar;43(4-5):450-4.
Kotani K, Caccavello R, Sakane N, Miyamoto M, Gugliucci A. Influence of ezetimibe monotherapy on ischemia-modified albumin levels in hypercholesterolemic patients. Pharmacol Rep. 2011;63(5):1248-51.
Mehmetoglu I, Yerlikaya FH, Kurban S, Erdem SS, Tonbul Z. Oxidative stress markers in hemodialysis and peritoneal dialysis patients, including coenzyme Q10 and ischemia-modified albumin. Int J Artif Organs. 2012 Mar;35(3):226-32.
Dursun A, Okumus N, Zenciroglu A. Ischemia-modified albumin (IMA): could it be useful to predict perinatal asphyxia? J Matern Fetal Neonatal Med. 2012 Nov;25(11):2401-5.
Gugliucci A, Hermo R, Monroy C, Numaguchi M, Kimura S. Ischemia-modified albumin levels in cord blood: a case-control study in uncomplicated and complicated deliveries. Clin Chim Acta. 2005 Dec;362(1-2):155-60.
Yakut I, Tayman C, Oztekin O, Namuslu M, Karaca F, Kosus A. Ischemia-modified albumin may be a novel marker for the diagnosis and follow-up of necrotizing enterocolitis. J Clin Lab Anal. 2014 May;28(3):170-7.
Oztekın O, Kalay S, Tayman C, Namuslu M, Celık HT. Levels of ischemia-modified albumin in transient tachypnea of the newborn. Am J Perinatol. 2015 Feb;30(2):193-8
Yerlikaya FH, Kurban S, Mehmetoglu I, Annagur A, Altunhan H, Erbay E, et al. Serum ischemia-modified albumin levels at diagnosis and during treatment of late-onset neonatal sepsis. J Matern Fetal Neonatal Med. 2014 Nov;27(17):1723-7.
Erol S, Unal S, Demirel N, et al. Evaluation of serum ischemia-modified albumin levels in anemia of prematurity. J Matern Fetal Neonatal Med 2018; 31:3133-3138.
Zuwała-Jagiełło J1, Warwas M, Pazgan-Simon M. Ischemia-modified albumin (IMA) is increased in patients with chronic hepatitis C infection and related to markers of oxidative stress and inflammation. Acta Biochim Pol. 2012;59(4):661-7.
Goldstein B, Giroir B, Randolph A; International Consensus Conference on Pediatric Sepsis. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med. 2005 Jan; 6(1):2-8.
Bar-Or D, Lau E, Winkler JV. A novel assay for cobalt-albumin binding and its potential as a marker for myocardial ischemia-a preliminary report. J Emerg Med. 2000 Nov; 19(4):311-5.
Lippi G, Montagnana M, Salvagno GL, Guidi GC. Standardization of ischemia-modified albumin testing: adjustment for serum albumin. Clin Chem Lab Med. 2007;45(2):261-2.
Sbarouni E, Georgiadou P, Voudris V. Ischemia modified albumin changes - review and clinical implications. Clin Chem Lab Med. 2011 Feb;49(2):177-84.
Erdem SS, Yerlikaya FH, Çiçekler H, Gül M. Association between ischemia-modified albumin, homocysteine, vitamin B(12) and folic acid in patients with severe sepsis. Clin Chem Lab Med. 2012 Feb 14;50(8):1417-21.
Iacovidou N, Briana DD, Boutsikou M, Liosi S, Baka S, Boutsikou T, et al. Cord blood ischemia-modified albumin levels in normal and intrauterine growth restricted pregnancies. Mediators Inflamm. 2008;2008:523081.
Silveira RD, Giacomini C, Procianoy RS. Neonatal sepsis and septic shock: concepts update and review. Rev Bras Ter Intensiva. 2010 Sep;22(3):280-290.
Lever A, Mackenzie I. Sepsis: definition, epidemiology, and diagnosis. BMJ. 2007 Oct 27;335(7625):879-83.
Buttery JP. Blood cultures in newborns and children: optimising an everyday test. Arch Dis Child Fetal Neonatal Ed. 2002 Jul;87(1):F25-8. Review.
Chiesa C, Natale F, Pascone R, Osborn JF, Pacifico L, Bonci E, et al. C reactive protein and procalcitonin: reference intervals for preterm and term newborns during the early neonatal period. Clin Chim Acta. 2011 May 12;412(11-12):1053-9.
Bhandari V. Effective Biomarkers for Diagnosis of Neonatal Sepsis, Journal of the Pediatric Infectious Diseases Society, Volume 3, Issue 3, September 2014, Pages 234–245.