ÖZET
Amaç:
Bu çalışmada akut metabolik dekompanzasyon olan sepsisli ve non-enfeksiyöz enflamatuvar durumlu hastaların fibroblast büyüme faktörü 21 (FGF 21) düzeylerini, enfeksiyon parametreleri ve skorlama sistemleri ile karşılaştırmak amaçlandı.
Gereç ve Yöntem:
Kesitsel olarak dizayn edilen çalışmada olgu grubuna 46 sepsis tanısı olan hasta ile 29 non-enfeksiyöz enflamatuvar durum tanısı olan hasta ve kontrol grubuna da 39 sağlıklı gönüllü dahil edildi. Tüm hastaların C-reaktif protein, prokalsitonin (PCT), sedimentasyon ve FGF 21 düzey ölçümleri yapıldı. Akut fizyoloji ve kronik sağlık değerlendirmesi-II, sequential organ failure assessment skorlamaları hesaplandı.
Bulgular:
Sepsis ve non-enfeksiyöz enflamatuvar durum gruplarındaki FGF 21 düzeyleri, kontrol grubuna göre anlamlı olarak daha yüksek bulundu (p˂0,001). FGF 21 düzeyi ile sadece PCT düzeyi arasında zayıf pozitif bir korelasyon olduğu görüldü (r=0,292 p=0,011). FGF 21 ölçümlerinin 492,4 pg/mL ve üzerinde olmasının %82,4 sensitivite ve %80 spesifisite ile sepsis ve non-enfeksiyöz enflamatuvar durum tanılarını öngörebildiği gösterildi.
Sonuç:
Sonuç olarak, FGF 21, enfeksiyöz tablolarda PCT gibi yükselmesi, ancak her akut tabloda artmaması nedeni ile akut faz reaktanı olarak kabul edilmesinden dolayı şüpheli bir parametre olarak değerlendirilebilir.
References
1
Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA 2016;315:801-10.
2
Hotchkiss RS, Karl IE. The pathophysiology and treatment of sepsis. N Engl J Med 2003;348:138-50.
3
Genga KR, Russell JA. Update of Sepsis in the Intensive Care Unit. J Innate Immun 2017;9:441-55.
4
Li X, Zhu Z, Zhou T, Cao X, Lu T, He J, et al. Predictive value of combined serum FGF21 and free T3 for survival in septic patients. Clin Chim Acta 2019;494:31-7.
5
van Engelen TSR, Wiersinga WJ, Scicluna BP, van der Poll T. Biomarkers in Sepsis. Crit Care Clin 2018;34:139-52.
6
Marik PE. Procalcitonin is an essential biomarker for hydrocortisone, ascorbic acid, and thiamine (HAT) therapy in patients with sepsis. Crit Care 2019;23:151.
7
Suárez-Santamaría M, Santolaria F, Pérez-Ramírez A, Alemán-Valls MR, Martínez-Riera A, González-Reimers E, et al. Prognostic value of inflammatory markers (notably cytokines and procalcitonin), nutritional assessment, and organ function in patients with sepsis. Eur Cytokine Netw 2010;21:19-26.
8
Reinhart K, Bauer M, Riedemann NC, Hartog CS. New approaches to sepsis: molecular diagnostics and biomarkers. Clin Microbiol Rev 2012;25:609-34.
9
Tomasiuk R, Mikaszewska-Sokolewicz M, Szlufik S, Rzepecki P, Lazowski T. The prognostic value of concomitant assessment of NT-proCNP, C-reactive protein, procalcitonin and inflammatory cytokines in septic patients. Crit Care 2014;18:440.
10
Dias AT, Matta Pde O, Nunes WA. Índices de gravidade em unidade de terapia intensiva adulto: avaliação clínica e trabalho da enfermagem [Severity indexes in an adult intensive care unit: clinical evaluation and nursing work]. Rev Bras Ter Intensiva 2006;18:276-81.
11
Luo XP, Wang HH, Hu SF, Wu SJ, Xie GH, Cheng BL, et al. [Comparison of three different organ failure assessment score systems in predicting outcome of severe sepsis]. Zhonghua Wai Ke Za Zhi 2009;47:48-50.
12
Trancă S, Petrișor C, Hagău N, Ciuce C. Can APACHE II, SOFA, ISS, and RTS Severity Scores be used to Predict Septic Complications in Multiple Trauma Patients? J Crit Care Med (Targu Mures) 2016;2:124-30.
13
Türe M, Memiş D, Kurt I, Pamukçu Z. Predictive value of thyroid hormones on the first day in adult respiratory distress syndrome patients admitted to ICU: comparison with SOFA and APACHE II scores. Ann Saudi Med 2005;25:466-72.
14
Goetz R, Beenken A, Ibrahimi OA, Kalinina J, Olsen SK, Eliseenkova AV, et al. Molecular insights into the klotho-dependent, endocrine mode of action of fibroblast growth factor 19 subfamily members. Mol Cell Biol 2007;27:3417-28.
15
Itoh N, Ohta H, Konishi M. Endocrine FGFs: Evolution, Physiology, Pathophysiology, and Pharmacotherapy. Front Endocrinol (Lausanne) 2015;6:154.
16
BonDurant LD, Ameka M, Naber MC, Markan KR, Idiga SO, Acevedo MR, et al. FGF21 Regulates Metabolism Through Adipose-Dependent and -Independent Mechanisms. Cell Metab 2017;25:935-44.e4.
17
Xie T, Leung PS. Fibroblast growth factor 21: a regulator of metabolic disease and health span. Am J Physiol Endocrinol Metab 2017;313:E292-302.
18
Suassuna PGA, de Paula RB, Sanders-Pinheiro H, Moe OW, Hu MC. Fibroblast growth factor 21 in chronic kidney disease. J Nephrol 2019;32:365-77.
19
Su X, Kong Y, Peng D. Fibroblast growth factor 21 in lipid metabolism and non-alcoholic fatty liver disease. Clin Chim Acta 2019;498:30-7.
20
Olszanecka-Glinianowicz M, Madej P, Wdowczyk M, Owczarek A, Chudek J. Circulating FGF21 levels are related to nutritional status and metabolic but not hormonal disturbances in polycystic ovary syndrome. Eur J Endocrinol 2015;172:173-9.
21
Gariani K, Drifte G, Dunn-Siegrist I, Pugin J, Jornayvaz FR. Increased FGF21 plasma levels in humans with sepsis and SIRS. Endocr Connect 2013;2:146-53.
22
Feingold KR, Grunfeld C, Heuer JG, Gupta A, Cramer M, Zhang T, et al. FGF21 is increased by inflammatory stimuli and protects leptin-deficient ob/ob mice from the toxicity of sepsis. Endocrinology 2012;153:2689-700.
23
Li X, Zhu Z, Zhou T, Cao X, Lu T, Liang Y, et al. Early increases in serum FGF21 levels predict mortality of septic patients. Cytokine 2018;111:428-33.
24
American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 1992;20:864-74.
25
Nasimfar A, Sadeghi E, Karamyyar M, Manesh LJ. Comparison of serum procalcitonin level with erythrocytes sedimentation rate, C-reactive protein, white blood cell count, and blood culture in the diagnosis of bacterial infections in patients hospitalized in Motahhari hospital of Urmia (2016). J Adv Pharm Technol Res 2018;9:147-52.
26
Wang S, Chen D. [The correlation between procalcitonin, C-reactive protein and severity scores in patients with sepsis and their value in assessment of prognosis]. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue 2015;27:97-101.
27
Camporez JP, Jornayvaz FR, Petersen MC, Pesta D, Guigni BA, Serr J, et al. Cellular mechanisms by which FGF21 improves insulin sensitivity in male mice. Endocrinology 2013;154:3099-109.
28
Véniant MM, Komorowski R, Chen P, Stanislaus S, Winters K, Hager T, et al. Long-acting FGF21 has enhanced efficacy in diet-induced obese mice and in obese rhesus monkeys. Endocrinology 2012;153:4192-203.
29
Yu Y, He J, Li S, Song L, Guo X, Yao W, et al. Fibroblast growth factor 21 (FGF21) inhibits macrophage-mediated inflammation by activating Nrf2 and suppressing the NF-kB signaling pathway. Int Immunopharmacol 2016;38:144-52.
