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SMJ // Article

Original Article

The Value of Neopterin and Procalcitonin in Patients with Sepsis

Authors: Nuriye Tasdelen Fisgin, MD, Yuksel Aliyazicioglu, MD, Esra Tanyel, MD, Ahmet Yilmaz Coban, PhD, Fatma Ulger, MD, Muammer Zivalioglu, MD, Saban Esen, MD, Hakan Leblebicioglu, MD

Abstract


Objective: Neopterin (NT) is a compound of low molecule-based pteridine. It is secreted by macrophages as a response to the stimulation of cytokines such as interferon-γ, interferon-1β, tumor necrosis factor α or bacteria compounds such as lipopolysaccharides. Procalcitonin (PCT) levels may increase in the course of bacterial, parasitic, and fungal infections. Therefore, it can be used for the differential diagnosis of the infection, especially in cases of serious inflammation. In this study, the role of NT, and PCT in sepsis as a prognostic factor, and the relationship between the two parameters are examined.


Methods: From November 1, 2005 through December 31, 2005, fifty patients with sepsis admitted to the Department of the Infectious Diseases and Clinical Microbiology and/or Department of Anaesthesiology and Reanimation were enrolled in the study. Patients were divided in two subgroups according to their survival: group I (n = 23) nonsurviving patients and group II (n = 27) surviving patients.


Results: Serum NT levels have been found to be increased in group I (median: 15 ng/mL, range: 2–69) when compared to group II (median: 5 ng/mL, range: 2–130). The difference was statistically significant (P = 0.03). Other laboratory parameters and PCT levels (group I median: 0.13; group II median: 0.08; P < 0.05) were not different between the two groups.


Conclusions: NT was found to be a prognostic factor in patients with sepsis.



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References

1.Ruokonen E, Ilkka L, Niskanen M, et al. Procalcitonin and neopterin as indicators of infection in critically ill patients. Acta Anaesthesiol Scand 2002;46:398–404.
 
2.de Werra I, Jaccard C, Corradin SB, et al. Cytokines, nitrite/nitrate, soluble tumor necrosis factor receptors, and procalcitonin concentrations: comparisons in patients with septic shock, cardiogenic shock, and bacterial pneumonia. Crit Care Med 1997;25:607–613.
 
3.Adamik B, Kübler-Kielb J, Golebiowska B, et al. Effect of sepsis and cardiac surgery with cardiopulmonary bypass on plasma level of nitric oxide metabolites, neopterin, and procalcitonin: correlation with mortality and postoperative complications. Intensive Care Med 2000;26:1259–1267.
 
4.Strohmaier W, Redl H, Schlag G, et al. D-erythro-neopterin plasma levels in intensive care patients with and without septic complications. Crit Care Med 1987;15:757–760.
 
5.Nathan CF. Secretory products of macrophages. J Clin Invest 1987;79:319–326.
 
6.Burleson DG, Johnson A, Salin M, et al. Identification of neopterin as a potential indicator of infection in burned patients. Proc Soc Exp Biol Med 1992;199:305–310.
 
7.Balogh D, Lammer H, Kornberger E, et al. Neopterin plasma levels in burn patients. Burns 1992;18:185–188.
 
8.Yoshida Y, Une F, Utatsu Y, et al. Adenosine and neopterin levels in cerebrospinal fluid of patients with neurological disorders. Intern Med 1999;38:133–139.
 
9.Le Moullec JM, Jullienne A, Chenais J, et al. The complete sequence of human preprocalcitonin. FEBS Lett 1984;167:93–97.
 
10.Schröder J, Staubach KH, Zabel P, et al. Procalcitonin as a marker of severity in septic shock. Langenbecks Arch Surg 1999;384:33–38.
 
11.Dandona P, Nix D, Wilson MF, et al. Procalcitonin increase after endotoxin injection in normal subjects. J Clin Endocrinol Metab 1994;79:1605–1608.
 
12.Whang KT, Vath SD, Becker KL, et al. Procalcitonin and proinflammatory cytokine interactions in sepsis. Shock 2000;14:73–78.
 
13.Claeys R, Vinken S, Spapen H, et al. Plasma procalcitonin and C-reactive protein in acute septic shock: clinical and biological correlates. Crit Care Med 2002;30:757–762.
 
14.Bone RC, Balk RA, Cerra FB, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest 1992;101:1644–1655.
 
15.Muller Kobold AC, Tulleken JE, Zijlstra JG, et al. Leukocyte activation in sepsis; correlations with disease state and mortality. Intensive Care Med 2000;26:883–892.
 
16.Bone RC. Immunologic dissonance: a continuing evolution in our understanding of the systemic inflammatory response syndrome (SIRS) and the multiple organ dysfunction syndrome (MODS). Ann Intern Med 1996;125:680–687.
 
17.Gérard Y, Hober D, Petitjean S, et al. High serum procalcitonin level in a 4-year-old liver transplant recipient with a disseminated candidiasis. Infection 1995;23:310–311.
 
18.Davis TM, Assicot M, Bohuon C, et al. Serum procalcitonin concentrations in acute malaria. Trans R Soc Trop Med Hyg 1994;88:670–671.
 
19.Oberhoffer M, Vogelsang H, Russwurm S, et al. Outcome prediction by traditional and new markers of inflammation in patients with sepsis. Clin Chem Lab Med 1999;37:363–368.
 
20.Huber C, Fuchs D, Hausen A, et al. Pteridines as a new marker to detect human T cells activated by allogeneic or modified self major histocompatibility complex (MHC) determinants. J Immunol 1983;130:1047–1050.
 
21.Faist E, Storck M, Hültner L, et al. Functional analysis of monocyte activity through synthesis patterns of proinflammatory cytokines and neopterin in patients in surgical intensive care. Surgery 1992;112:562–572.
 
22.Roumen RM, Redl H, Schlag G, et al. Inflammatory mediators in relation to the development of multiple organ failure in patients after severe blunt trauma. Crit Care Med 1995;23:474–480.
 
23.Gómez-Jiménez J, Martín MC, Sauri R, et al. Interleukin-10 and the monocyte/macrophage-induced inflammatory response in septic shock. J Infect Dis 1995;171:472–475.
 
24.Hotchkiss RS, Swanson PE, Freeman BD, et al. Apoptotic cell death in patients with sepsis, shock, and multiple organ dysfunction. Crit Care Med 1999;27:1230–1251.
 
25.Godai K, Uemasu J, Kawasaki H. Clinical significance of serum and urinary neopterins in patients with chronic renal disease. Clin Nephrol 1991;36:141–146.
 
26.Delogu G, Casula MA, Mancini P, et al. Serum neopterin and soluble interleukin-2 receptor for prediction of a shock state in gram-negative sepsis. J Crit Care 1995;10:64–71.
 
27.Brunkhorst FM, Eberhard OK, Brunkhorst R. Discrimination of infectious and noninfectious causes of early acute respiratory distress syndrome by procalcitonin. Crit Care Med 1999;27:2172–2176.