Diagnostic and prognostic role of presepsin neopterin and procalcitonin in the diagnosis of sepsis in immunocompromised patients
Project no. 20829 · Status: Kapanmış (Yayın bekleniyor) · 2019
Summary
Primary immunodeficiency disorders (PIDs) are diseases that result from defects in one or more components of the immune system and are clinically characterized by recurrent infections. Early diagnosis is important for early initiation of life-saving treatments and prevention of possible complications. Bacterial, mycobacterial, viral, fungal and protozoal infections may lead to severe complications in PID patients. Various biomarkers are used in the diagnosis, follow-up and prognosis of the infection. The most used acute phase reactants in clinical practice are; C-Reactive Protein(CRP), procalcitonin(PCT), erythrocyte sedimentation rate(ESR) and serum amyloid A(SAA). Biomarkers such as presepsin and neopterin are new biomarkers that are used in clinical diagnosis and in the follow-up of diseases. The aim of the study is to investigate the role of presepsin and neopterin, in the diagnosis of infection in immunocompromised patients, and investigate their superiority and/or safety compared to other well-known acute phase reactants such as CRP and procalcitonin. MATERIALS and METHOD: Patients aged 0-18 years, who presented with complaints of fever, circulatory collaps, and respiratory distress and were hospitalized with the preliminary diagnosis of bacteremia, sepsis, and septic shock were included.The laboratory and clinical information of these patients were obtained from their files and electronic records. Laboratory findings (hemogram,CRP,presepsin,procalcitonin,neopterin), causative microorganism, and type of isolated microorganism were recorded. The conformity of the variables was examined using the Shapiro-Wilk(n<50) and Kolmogorov-Smirnov(n>=50) tests. ROC (Receiver Operating Characteristic) analysis was performed to obtain the diagnostic accuracy of the parameters and the optimal cutoff point. RESULTS: Of 39 patients, 13 (33.3%) were female and 26 (66.7%) were male. The median age of the patient group was 111 months(4-216 months). Of the control group, 17(45.9%) were female and 20(54.1%) were male. The median age of the control group was 92 months(9–199 months). Predominantly antibody deficiency (20.5%,n=8) and quantitative and/or functional defects of phagocytic cells (20.5%,n=8) were the most common groups in the patient group. Infection was the first presenting symptom in 87%(n=34) of the patients. The most common type of infection was lower respiratory tract infection (87%,n=34). The most sensitive and specific biomarkers for the detection of infection were presepsin and neopterin, respectively. There was no significant difference between the laboratory findings (hemogram,CRP,presepsin,procalcitonin,neopterin ) in the patient group according to the presence of the causative microorganism at the time of infection, localized/invasive nature of the infection, or the type of isolated microorganism. Tthe correlations between CRP and WBC, CRP and presepsin, presepsin and neopterin were statistically significant with weak relationship. CONCLUSION: It is important to prevent infections in patients with PID, to recognize infections early and treat them quickly and aggressively for the risk of sepsis, and to prevent organ damage. Presepsin and neopterin will be used more frequently as they are specific and sensitive compared to CRP, PCT, and hemogram parameters that we use frequently. Although there are many studies in the literature investigating the role of these parameters in sepsis and septic shock, there is no study showing the power of detecting infection in patients with PID, and in this respect, our research becomes important. Of course, more clinical studies are needed for the reliability and usability of new biomarkers.