207
Journal of Neonatal-Perinatal Medicine 7 (2014) 207–212 DOI 10.3233/NPM-14814014 IOS Press
Original Research
Serum apelin in early-onset neonatal sepsis: Is it diagnostic? G.I. Gada , R.I.H. Ismaila,∗ , S.A. El-Masryb and H.R. Goudac a Pediatrics,
Faculty of Medicine, Ain Shams University, Cairo, Egypt Pathology, Faculty of Medicine, Ain Shams University, Cairo, Egypt c Ain Shams University, Cairo, Egypt b Clinical
Received 2 February 2014 Revised 14 July 2014 Accepted 9 September 2014
Abstract. OBJECTIVE: To evaluate the diagnostic value of serum apelin in early-onset neonatal sepsis in full term neonates. Apelin is a proinflammatory adipocyte-derived factor that participates in vascular wall inflammation. STUDY DESIGN: Case-control study was conducted on 60 full term neonates, 30 cases with early-onset neonatal sepsis and 30 healthy matched controls. Complete blood counts, C-reactive protein, blood cultures, plasma lactate, and serum apelin concentrations (measured by enzyme-linked immunosorbent assay) were determined initially at the time of sepsis diagnosis and 4 days after starting treatment for cases. Only basal serum apelin concentrations were measured for control group. RESULTS: Apelin was detected in all neonates and concentrations were positively correlated to sepsis scores, plasma lactate and CRP. Neonates with sepsis had significantly elevated concentrations (8 folds increase) of serum apelin concnetration as compared to controls [median (IQR): 65.16(46.90) and 7.969(11.36) pg/ml, respectively]. Moreover initial serum apelin concentration measured in cases with culture proven neonatal sepsis was significantly higher than those with negative-culture clinical sepsis (mean ± SD: 73.53 ± 31.77 and 45.22 ± 5.9 respectively, p = 0.0001). The best cutoff value of serum apelin to diagnose early-onset neonatal sepsis was 30.225 pg/ml with a sensitivity of 100% and a specificity of 97%. CONCLUSION: Serum apelin may have a diagnostic value in early-onset neonatal sepsis. Keywords: Apelin, neonate, sepsis
1. Introduction Early-onset neonatal sepsis (EONS), diagnosed during the first 3 days of life, remains a major cause of neonatal morbidity and mortality [1]. Clinical diagnosis of neonatal sepsis is difficult because of the non-specific nature of signs and symptoms; hence, ∗ Corresponding
author: Dr. Rania Ibrahim Hossni Ismail, Department of Pediatrics, Ain Shams University, Ramses Street, Cairo 11566, Egypt. Tel.: +20 01144447769; E-mail: rania74rania@ hotmail.com.
antibiotics are often started empirically based on the presence of perinatal risk factors [2]. White adipose tissue is a major endocrine organ that regulates energy homeostasis and other physiological processes by releasing several factors called adipokines. A variety of adipokines has been discovered over the last years that regulate different systemic processes in an autocrine, paracrine or endocrine manner [3]. Apelin, member of the adipose-secreted cytokine family, was identified in 1998 as an endogenous ligand of the human orphan G protein-coupled receptor
1934-5798/14/$27.50 © 2014 – IOS Press and the authors. All rights reserved
Journal of Neonatal-Perinatal Medicine 7 (2014) 207–212 DOI 10.3233/NPM-14814014 IOS Press
Original Research
Serum apelin in early-onset neonatal sepsis: Is it diagnostic? G.I. Gada , R.I.H. Ismaila,∗ , S.A. El-Masryb and H.R. Goudac a Pediatrics,
Faculty of Medicine, Ain Shams University, Cairo, Egypt Pathology, Faculty of Medicine, Ain Shams University, Cairo, Egypt c Ain Shams University, Cairo, Egypt b Clinical
Received 2 February 2014 Revised 14 July 2014 Accepted 9 September 2014
Abstract. OBJECTIVE: To evaluate the diagnostic value of serum apelin in early-onset neonatal sepsis in full term neonates. Apelin is a proinflammatory adipocyte-derived factor that participates in vascular wall inflammation. STUDY DESIGN: Case-control study was conducted on 60 full term neonates, 30 cases with early-onset neonatal sepsis and 30 healthy matched controls. Complete blood counts, C-reactive protein, blood cultures, plasma lactate, and serum apelin concentrations (measured by enzyme-linked immunosorbent assay) were determined initially at the time of sepsis diagnosis and 4 days after starting treatment for cases. Only basal serum apelin concentrations were measured for control group. RESULTS: Apelin was detected in all neonates and concentrations were positively correlated to sepsis scores, plasma lactate and CRP. Neonates with sepsis had significantly elevated concentrations (8 folds increase) of serum apelin concnetration as compared to controls [median (IQR): 65.16(46.90) and 7.969(11.36) pg/ml, respectively]. Moreover initial serum apelin concentration measured in cases with culture proven neonatal sepsis was significantly higher than those with negative-culture clinical sepsis (mean ± SD: 73.53 ± 31.77 and 45.22 ± 5.9 respectively, p = 0.0001). The best cutoff value of serum apelin to diagnose early-onset neonatal sepsis was 30.225 pg/ml with a sensitivity of 100% and a specificity of 97%. CONCLUSION: Serum apelin may have a diagnostic value in early-onset neonatal sepsis. Keywords: Apelin, neonate, sepsis
1. Introduction Early-onset neonatal sepsis (EONS), diagnosed during the first 3 days of life, remains a major cause of neonatal morbidity and mortality [1]. Clinical diagnosis of neonatal sepsis is difficult because of the non-specific nature of signs and symptoms; hence, ∗ Corresponding
author: Dr. Rania Ibrahim Hossni Ismail, Department of Pediatrics, Ain Shams University, Ramses Street, Cairo 11566, Egypt. Tel.: +20 01144447769; E-mail: rania74rania@ hotmail.com.
antibiotics are often started empirically based on the presence of perinatal risk factors [2]. White adipose tissue is a major endocrine organ that regulates energy homeostasis and other physiological processes by releasing several factors called adipokines. A variety of adipokines has been discovered over the last years that regulate different systemic processes in an autocrine, paracrine or endocrine manner [3]. Apelin, member of the adipose-secreted cytokine family, was identified in 1998 as an endogenous ligand of the human orphan G protein-coupled receptor
1934-5798/14/$27.50 © 2014 – IOS Press and the authors. All rights reserved
