Prognostička vrednost faktora nekroze tumora alfa, monocitnog hemoatraktantnog proteina-1 i neuron-specifične enolaze kod bolesnika sa encefalopatijom izazvanom sepsom
Sažetak
Uvod/Cilj. Encefalopatija izazvana sepsom (EIS) je teška komplikacija sepse, koju karakteriše disfunkcija mozga, a povezana je sa lošom prognozom. Patogeneza EIS je složena, a težina njene manifestacijhe je u bliskoj korelaciji sa nivoima različitih faktora u serumu. Cilj rada bio je da se ispita korelacija nivoa faktora nekroze tumora (tumor necrosis factor-TNF)-α, monocitnog hemoatraktantnog proteina (monocyte chemoattractant protein-MCP)-1 i neuron-specifične enolaze (NSE) sa težinom EIS i analizira prognostička vrednost ova tri parametra. Metode. Ovom prospektivnom studijom obuhvaćena su 126 bolesnika sa EIS, lečena u periodu od juna 2020. do juna 2022. godine. Određivani su nivoi TNF-α, MCP-1 i NSE, a težina EIS procenjena je korišćenjem skora procene sekvencijalnog popuštanja organa (Sequential Organ Failure Assessment – SOFA). Na osnovu SOFA skora, bolesnici su podeljeni u dve grupe – grupu sa lošom prognozom i grupu sa dobrom prognozom. Analizirane su korelacije nivoa TNF-α, MCP-1 i NSE sa težinom EIS, a njihove prognostičke vrednosti procenjivane su tokom 28-dnevnog praćenja. Rezultati. Prosečni nivoi TNF-α, MCP-1, NSE i SOFA skora kod 126 bolesnika sa EIS bili su 6,52 ± 1,48 pg/mL, 62,53 ± 18,49 pg/mL, 8,61 ± 2,17 ng/mL i 10,24 ± 2,86 poena, redom. Pirsonova analiza pokazala je značajne korelacije između nivoa TNF-α, MCP-1 i NSE i SOFA skora bolesnika sa EIS (r > 0, p < 0,05). Od 126 bolesnika, njih 61 (48,4%) imalo je lošu prognozu, dok je njih 65 (51,6%) imalo dobru prognozu. Faktori rizika za lošu prognozu kod bolesnika sa EIS bili su povišeni nivoi TNF-α, MCP-1 i NSE u serumu [odds ratio (OR) > 1, p < 0,05]. Površine ispod receiver operating characteristic (ROC) krive za TNF-α, MCP-1 i NSE u serumu bile su > 0,7, što ukazuje na visoke prognostičke vrednosti tih parametara. Zaključak. Nivoi TNF-α, MCP-1 i NSE usko su povezani sa težinom EIS i mogu biti vredni prediktori ishoda lečenja.
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