Akademik Veri Yönetim Sistemi
Van Tıp Dergisi, cilt.28, sa.3, ss.380-388, 2021 (Hakemli Dergi)
Objective: This study aimed to measure neopterin levels in serum and bronchoalveolar lavage fluid to determine the diagnostic and prognostic value of neopterin in sepsis. Materials and Methods: This descriptive, cross-sectional study included intensive care patients over the age of 18 who underwent invasive mechanical ventilation and blood and bronchoalveolar lavage sampling at admission. Forty-five patients were analyzed retrospectively as those with sepsis (n=22) and without sepsis (n=23). Results: Serum and bronchoalveolar lavage neopterin concentrations were statistically significantly higher in patients with sepsis. Neopterin level in serum and bronchoalveolar lavage fluid had good predictive value for the diagnosis of sepsis, with cut-off values of 22.04 nmol/L (Area under curve- AUC 85.8%) and 2.61 nmol/L (AUC 76.1%), respectively. C- reactive protein, on the other hand, had a predictive value of 86.1% for the diagnosis of sepsis, with a cut-off value of 73.25 mg/L. Serum neopterin and C-reactive protein were determined as independent risk factors for sepsis. When these two biomarkers were used together, they showed the best predictive value (AUC 93.3%) for the diagnosis of sepsis. Bronchoalveolar lavage neopterin correlated with clinical pulmonary infection score. Serum neopterin level was significantly higher in sepsis patients who developed septic shock than in those who did not. Conclusion: Serum neopterin had comparable diagnostic value in sepsis to the widely used biomarker, procalcitonin. Combined use with C-reactive protein increases the diagnostic value, specificity, and sensitivity of serum neopterin in sepsis. Serum neopterin can also be used as a prognostic indicator and may be predictive of the rapidly developing processes that lead to shock. Despite the lower value of bronchoalveolar lavage neopterin for the diagnosis of sepsis, its correlation with clinical pulmonary infection score suggests that it may indicate disease severity in ventilator-associated pneumonia.