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UIMM
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volume 2, issue 8, 2024 ISSN: 2995-5319
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INTERNATIONAL JOURNAL OF
INTEGRATIVE AND
MODERN MEDICINE
Significance of Presepsin in the Early Diagnosis of Sepsis in Children
Hamraeva G. SH.
Center for the development ofprofessional skills of medical workers
Razikova Sh. K., Mirakbarova N. T.
Republican Scientific Center of Emergency Medical Care
Annotation: Resume.
Infectious
processes
occurring
in
children of early age often have a
non-specific
clinical
appearance.
This, in turn.
can
lead to interpretation of
symptoms
and late diagnosis of the
disease.
The purpose
of
the
study is to
determine the significance
of
the amount
of
presepsin in lhe blood
plasma
in the
early
diagnosis
of
sepsis in young
children.
Materials and methods.
62
children
with
early age
sepsis
were included in the study. Among them,
27 patients
made
up
the comparison group i.e. children not
complicated by sepsis,
and
35 patients
made
up
the
main
group -
children
with
sepsis
caused
by
pneumonia.
Result. When the level
of
presepsin
was
checked on the lst-3rd
days
of hospitalization,
it
was found that the level
of presepsin in the
blood
plasma of the patients
of
the main group
was
significantly higher than that of the
patients
of the control
group. (358.9 [279.8 - 675.7]
and
245.6 [125-353]).
In addition, it
was
found that there
is a
correlation
(r<0.05) between
the duration of time the
patients
on the mechanical ventilator and lhe high level of
presepsin
in
the
blood (R=0.34;
r=0
02)
Conclusion.
Presepsin
level
in blood plasma
exceeding 325 ngl can serve
as a diagnostic
cntery for the
possibility
of sepsis
in the
background
of pneumonia.
Keywords:
pediatrics, pneumonia, sepsis, presepsin.
Incomplete functioning
of
children's immune
system leads to
rapid spread of infectious
process, rapid
formation
of
systemic
inflammatory reaction and damage to various organs. The percentage of
fatal cases
caused
by sepsis
in premature children
is
characterized
by
high
indicators (from
15 to
50%), this
condition is
associated
with
insufficient development of immunity' In addition, there are
risk factors
for the development of nosocomial
sepsis,
which include
an
increase in the number of invasive
measures, as
weh
as
long-term treatment
of
children in the
intensive
care and
intensive care
units.
[3. 16,
13].
Starting on time the antibiotic therapy and microbiological
analysis of
the
blood
collected earlier, adequate infusion
and vasopressor
therapy
with dynamic
checking
of
lactate
and
presepsin concentrations lead
to a 3 .9%
decrease
in
the lethality rate among children. [16].
Thus, at present there
is
no universal laboratory method for
early diagnosis
due to the variety
of
factors that
cause
sepsis
and the inadequacy of
specific
aspects
of sepsis
clinic. Development of new, integrated
approaches
and
improvement of
laboratory
diagnostic methods
of sepsis early'
diagnosis, monitoring guarantee the ability'
to
predict
and
reduce negative consequences.
The "perfect" marker of
sepsis
should
provide
reliable monitoring
of
the effectiveness
of
the treatment given to the
patient. Unlike reference biomarkers,
its indicators
help
to start
antibacterial therapy' on time. Delaying
antibiotic
therapy' even
by
1 hour leads to
an
increase in the level
of
lethality
[1,
5,11].
Presepsin
(PSP) is
a marker of the N-terminal
part
of the CD14 macrophage receptor,
and
its concentration in the
blood
increases
rapidly' in
systemic
inflammation,
sepsis,
and
septic
shock. Presepsin
was discovered by
Japanese
scientists Yoshikazu Okamura
and Ralph Thome in
2005.
PSP exists in
two
foniE: cm the
surface
of macrophages,
monocytes, granulocytes in a membrane-bound state
(mCD14)
and in a soluble state circulating in the
bloodstream
(sCD14.
s-
soluble) [2, 7,
13.
17].
As soon
as
the bacteria enters the
bloodstream,
the components of its cell wall bind to this receptor,
which
leads
totemaft'onal Journal of/пеедлайуе onef Modern Medicine
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AuthoijsJ. This
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distributed
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ribution
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and reproduction
in
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medium
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is
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to the activation of phagocytosis. When the protein components of
bacteria
begin to break down, proteinases
simultaneously
break
down
the mCD14 receptor and form a specific protein fragment
with
a molecular weight of
13 kDa. which can be detected in rhe bloodstream
[6. 8,12,4].
It has been noted that in sepsis the increase in the level of PSP occurs faster than the increase in markers such as
TNF-а, IL-6,
IL-
10,
PCT. and CRP
[9, 12,
15].
Material
and
methods.
The clinical research
was
conducted in
2023-2024
at the "Republican Emergency Medical Research Center" in the
departments of pediatric
ICTJ
and
pediatrics
1.
Study
inclusion criteria:
>
children
who
had a complicated delivery
>
patients with suspected immunodeficiency
>
the presence of two or more clinical manifestations of
sepsis;
>
X-ray confirmed signs of pneumonia
>
poly
organic
deficiency;
Exclusion criteria:
>
newborn babies up to
1
month
>
genetic pathology
and
metabolic diseases:
>
several
malformations, congenital heart and kidney defects.
Pneumonia
was
diagnosed
based
on medical history; clinical laboratory and X-ray examination. At the same time,
pregnancy and childbirth anamnesis, premoibid background, previous diseases, antibiotic therapy treatments
received in ambulatory' and inpatient conditions were also studied.
All children aged
1
to 3
years
with
suspected pneumonia complicated
by sepsis
were included in this study. The
main (first) group included
patients
aged 1 mouth to
3 years
who had a score of more than 2 on the
qSOFA scale
upon
arrival
at the clinic, suspected or confirmed pneumonia complicated
by sepsis
treated
at
BSR. and had signs
of poly organic failure. Children aged 1 mouth to
3
years, whose pneumonia
was
complicated
by sepsis,
but
who
did not have signs of poly organic failure, were included. All patients were tested for the detection of the Presepsin
marker in the
blood
plasma for the purpose of
early diagnosis
of sepsis. The main material of rhe study
was
the
blood
collected from the peripheral and central veins of the patients.
A hematology analyzer MINDREY BC-5300
(Shenzhen
Mindray Bio-Medical Electronics
Co..
Ltd.. China)
was
used
for complete blood
analysis.
Venous blood collected from the
patient
and plasma
stored
at under all storage
conditions
were
used
in the
procedures of the examination. The
analysis w
r
as
c arried out in the special
laboratory'
of the Republican
Emergency Medical Research Center, strictly following the instructions given
by
the manufacturers of the test
system.
Analysis
of the obtained
results is
done using the method of correlational
analysis and "Statistica 6.
1". conducted
using the standard package. The obtained results are presented in rhe form of M±SD. where
M
is
the arithmetic
mean value, SD is
the
standard
deviation.
For visualization of statistical significance non-parametric U-criterion Mann-Whitney and Spearman's correlation
coefficient were used. ROC
analysis was also
performed.
international Journal of integrative and Modern Medicine
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®
2O2<1 The
Authors). This
is
an open-access article distributed under the terms
of
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Attribution License
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r
which
permits
unrestricted use,
distribution,
and
reproduction in any medium
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provided
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«work
is
property
dted.
Results and their analysis.
32
patients
in the main group were connected
to
the mechanical ventilator. Depending on the
seventy or
severity of the
pathological process,
the connection to the
ventilator
lasted
from
1-2
to
10-14
days.
Children
who were connected
to
the ventilator for more than
1
week
had
signs
of
poly
organic failure
(p=0.02).
’
’
’
AU
patients
were treated with pathogenetic
and symptomatic
treatment, taking
into
account
antibacterial
and
vital parameters.
During the
standard laboratory
tests, the
laboratory'
criteria of
inflammation
were noted- leukocytosis in the
blood,
shift
of
the leukocyte
formula
to the left, increase in the amount
of
C
-reactive protein and
procalcitonin.
In the
comparative analysis
of inflammation
indicators
in the general
blood analysis,
the differences in
leukocytosis in the main and
control groups
were
16.7 [9.4-18.7]
and
16.0 [8.8-17.4]) C
reactive
protein
(r<0.05)
increased almost the same in
both
groups
(6.2
[5.
5-7.0] gl) (6.5 [5.1-7.6]) was
recorded,
(table
1)
Table 1. Data of the general blood test (leukocytes, leukocyte formula) and CRP in patients of the study groups.
Parametres
Patients with sepsis
caused by
pneumonia(n=30)
Patients with septic
shock(n=5)
Control group
(patients with
pneumonia) (n=27)
leucocytes(xl
09/л)
13.8 [9.1-16,2]
16.8 [8.8-17,41*
13,5
[9,72-15,7]
Band
neutrophils(%)
4.8 [3,5-5.2]
5.4 [3.9-6.4]
4,1
[2.9-4,71
Seg.neut.(%)
39,8
[3
1.6-47,5]
43,65 [28,648,9]
41.6 [32,747,6]
CRB(mg.'ml)
5,3 [4,2-6,8]
6,2 [5.5-7.01
6.1
[5.1-7.61)
Notes: *
-P<0,05.
A
significant increase in presepsin level on days 1-3 was observed
more
in the
children of
the main group than
in
the
control
group 458.9
[379.8-675.7]
and 245.6 [125-353].
It
was
found
that there
is a
positive
correlation
(r<0.05)
between
the
duration of the
time the patients
on
ventilator
and the
high
level
of presepsin
in the blood
(R=0.34:
r=0.02).
Analyzing
the level of
presepsin.
it
should
be
noted
that the level
of presepsin was significantly
higher in
patients
with
sepsis complicated
by
poly organic failure.
(1=0.0002).
(table
2)
Table 2.Concentration of presepsin in blood plasma.
Days
Patients with sepsis
caused by
pneumouia[n=30)
Patients
with
septic shock
(n=5)
Control group(patients
with pneumonia)[a=2 7)
I
-
day
245.6 [125-3531*
358.9
[279.8-675.7]*"
150.6 [68-248]’*
3
rd
day
238 [63423]*
325,5 [191-825]"*
124,5 [90-167]"
Notes:
* -Pl-2<0,01; **
-Pl
3-0.05: ***-P2-3<0,001.
ROC analysis
was
performed for early diagnosis of sepsis in early' age children. A presepsin level higher than
325 ngl on the lst-3rd day' of hospitalization is
a
criteria for the occurrence of sepsis against the background of
pneumonia (Fig.
1).
international Journal of integrative and Modern Medicine
Copyright
®
2024 The
Authors). This is
ar open-access article distributee under the terms of the Creative
Commons
Attribution License
(http://creativeciommons.Org/1icenses/bY/4O|, which permits
unrestricted use.
distribution,
and
reproduction
in
any medium
75
provided
the original
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properly
dted.
False Positive
Conclusion.
1.
The level of presepsin increases
in
patients
with
sepsis and reflects the
severity
of the inflammatory
process.
2.
The limit
value
of presepsin for early diagnosis
of sepsis
is
325 ng 1.
3.
Monitoring of presepsin
during
the
antibacterial
treatment reflects
its
effectiveness more clearly than C-
reactive protein.
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