Značaj određivanja solubilnog CD14 podtipa - presepsina u trahealnom aspiratu u diferencijalnoj dijagnozi infekcije novorođenčeta

Abstract

APSTRAKT Uvod: Ova studija obuhvata prenatalne i intrapartalne riziko-faktore rane neonatalne infekcije uključujući i nezreo imunski sistem uz kratak pregled imunskih markera, koji su do sada izučavani sa posebnim osvrtom na solubilni CD14 podtip- presepsin, kao ciljni marker. Materijal i metode: U studiji je uključeno 60 pacijenata (novorođene dece) hospitalizovane u Jedinici intenzivne neonatalne nege. Istraživanje je sprovedeno u 2 faze: u prvom delu je ispitivana uzajamna veza trahealnih vrednosti presepsina i nastanka rane neonatalne sepse, a u drugom delu veza ciljnog markera i rane neonatalne pneumonije. Dobijeni podaci grupisani su prema različitim kriterijumima i međusobno poređeni. Podaci su statistički obrađeni ``SPSS 20.0``programom. Demografski podaci prikazani su metodom deskriptivne statistike. Nakon testiranja normalnosti raspodele podataka koji su obrađivani korišćeni su Studentov T- test i Mann Whitney test. Hipoteze su testirane na nivou značajnosti p=0,05. Senzitivnost i specifičnost prikazana je ROC krivama. Rezultati: Dobijeni rezultati ukazuju na to da se presepsin iz trahealnog aspirata može koristiti kao pouzdan marker rane neonatalne pneumonije, sa cut off vrednošću od 582 pg/ml, (za senzitivnost 0,545455 i specifičnost 0,77551), kao i za praćenje uspešnosti lečenja. Izolovano posmatrani konvencionalni markeri inflamacije: broj neutrofila, CRP i PCT nisu bili dovoljno pouzdani markeri rane neonatalne infekcije (pneumonija, konatalna sepsa ili SIRS ). Sa druge strane, nivo LPS-CD14 (detektovan iz plazme) je bio indikativno viši u ispitivanoj, u odnosu na kontrolnu grupu, ali bez statističke značajnosti. Zaključak: Presepsin dobijen iz trahealnog aspirata je značajan marker rane neonatalne pneumonije. U dijagnozi rane sepse novorođenčeta, može se koristiti kao dopunska dijagnostika.

ABSTRACT Introduction: This study includes prenatal and intrapartal risk factors for early neonatal infection including an immature immune system with a brief overview of immune markers, which have been studied so far with a particular focus on soluble CD14 subtype-presepsin as the target marker. Material and Methods: The study involved 60 patients (newborns) hospitalized in the Intensive Neonatal Unit Care. The study was conducted in 2 phases: in the first part was investigated the interrelation between tracheal values of presepsin and the occurrence of early neonatal sepsis, and in the second part relationship between target marker and early neonatal pneumonia. The obtained data are grouped according to different criteria and compared to each other. The data was statistically analyzed by `` SPSS 20.0`` program. Demographic data are presented using descriptive statistics. After testing the normality of data distribution that was processed, Student's T-test and Mann Whitney test were used. The hypotheses were tested at the significance level p = 0.05. Sensitivity and specificity are represented by ROC curves. Results: The obtained results suggest that presepsin from tracheal aspirate can be used as a reliable marker of early neonatal pneumonia, with a cut off value of 582 pg / ml (for sensitivity 0.545455 and specificity 0.77551), as well as for monitoring effect of the treatment. Isolated observed conventional inflammation markers: the number of neutrophils, CRP and PCT were not sufficiently reliable markers of early neonatal infections (pneumonia, congenital sepsis, or SIRS). On the other hand, the level of LPS-CD14 (detected from the plasma) was indicatively higher in the test, compared to the control group, but without statistical significance. Conclusion: Presepsin obtained from tracheal aspirate is a significant marker of early neonatal pneumonia. In the diagnosis of early sepsis in the newborns, it can be used as an additional diagnostic test.