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Evaluation of New Diagnostic Biomarkers in Pediatric Sepsis: Matrix Metalloproteinase-9, Tissue Inhibitor of Metalloproteinase-1, Mid-Regional Pro-Atrial Natriuretic Peptide, and Adipocyte Fatty-Acid Binding Protein.

Alqahtani MF, Smith CM, Weiss SL, Dawson S, Ralay Ranaivo H, Wainwright MS - PLoS ONE (2016)

Bottom Line: A-FaBP levels in septic patients with neurological dysfunction (29.3, 17.2-54.6, 7) were significantly increased compared to septic patients without neurological dysfunction (14.6, 13.3-20.6, 11).MMP-9/TIMP-1 ratios were significantly lower, while A-FaBP and mrProANP were higher in septic patients compared to the control groups.Each biomarker was associated with hospital morbidity and length of stay.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, Divisions of Critical Care, Ann & Robert. H. Lurie Children's Hospital of Chicago, Northwestern Feinberg School of Medicine, Chicago, Illinois, United States of America.

ABSTRACT
Elevated plasma concentrations of matrix metalloproteinase-9 (MMP-9), tissue inhibitor of metalloproteinase-1 (TIMP-1), mid-regional pro-atrial natriuretic peptide (mrProANP), and adipocyte fatty-acid-binding proteins (A-FaBPs) have been investigated as biomarkers for sepsis or detection of acute neurological injuries in adults, but not children. We carried out a single-center, prospective observational study to determine if these measures could serve as biomarkers to identify children with sepsis. A secondary aim was to determine if these biomarkers could identify children with neurologic complications of sepsis. A total of 90 patients ≤ 18 years-old were included in this study. 30 with severe sepsis or septic shock were compared to 30 age-matched febrile and 30 age-matched healthy controls. Serial measurements of each biomarker were obtained, beginning on day 1 of ICU admission. In septic patients, MMP9-/TIMP-1 ratios (Median, IQR, n) were reduced on day 1 (0.024, 0.004-0.174, 13), day 2 (0.020, 0.002-0.109, 10), and day 3 (0.018, 0.003-0.058, 23) compared with febrile (0.705, 0.187-1.778, 22) and healthy (0.7, 0.4-1.2, 29) (p< 0.05) controls. A-FaBP and mrProANP (Median, IQR ng/mL, n) were elevated in septic patients compared to control groups on first 2 days after admission to the PICU (p <0.05). The area under the curve (AUC) for MMP-9/TIMP-1 ratio, mrProANP, and A-FaBP to distinguish septic patients from healthy controls were 0.96, 0.99, and 0.76, respectively. MMP-9/TIMP-1 ratio was inversely and mrProANP was directly related to PIM-2, PELOD, and ICU and hospital LOS (p<0.05). A-FaBP level was associated with PELOD, hospital and ICU length of stay (p<0.05). MMP-9/TIMP-1 ratio associated with poor Glasgow Outcome Score (p<0.05). A-FaBP levels in septic patients with neurological dysfunction (29.3, 17.2-54.6, 7) were significantly increased compared to septic patients without neurological dysfunction (14.6, 13.3-20.6, 11). MMP-9/TIMP-1 ratios were significantly lower, while A-FaBP and mrProANP were higher in septic patients compared to the control groups. Each biomarker was associated with hospital morbidity and length of stay. These results suggest that these biomarkers merit further prospective study for the early identification of children with sepsis.

No MeSH data available.


Related in: MedlinePlus

Receiver operating characteristic curves for biomarker discrimination between septic versus control febrile and healthy subjects.ROC curves for MMP-9/TIMP-1 ratio, mr-ProANP and A-FABP levels for (A) septic versus febrile subjects; (B) septic versus healthy subjects and (C) febrile versus healthy subjects. Triangle, A-FABP levels; Circle, mr-ProANP levels; Square, MMP-9/TIMP-1 ratio.
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pone.0153645.g003: Receiver operating characteristic curves for biomarker discrimination between septic versus control febrile and healthy subjects.ROC curves for MMP-9/TIMP-1 ratio, mr-ProANP and A-FABP levels for (A) septic versus febrile subjects; (B) septic versus healthy subjects and (C) febrile versus healthy subjects. Triangle, A-FABP levels; Circle, mr-ProANP levels; Square, MMP-9/TIMP-1 ratio.

Mentions: The AUROC for MMP-9/TIMP-1 ratios on day 1 to discriminate septic patients from febrile controls was 0.86, (95% CI 0.74, 0.96), (Fig 3A) and from healthy controls was 0.96, (95% CI 0.91, 1.0 (both p<0.001) (Fig 3B). This ratio did not discriminate between febrile and healthy controls (0.52, 95% CI 0.34, 0.70) (Fig 3C). The MMP9/TIMP1 cut-point of < 0.36 yielded a sensitivity of 95% and specificity of 70% to diagnose sepsis.


Evaluation of New Diagnostic Biomarkers in Pediatric Sepsis: Matrix Metalloproteinase-9, Tissue Inhibitor of Metalloproteinase-1, Mid-Regional Pro-Atrial Natriuretic Peptide, and Adipocyte Fatty-Acid Binding Protein.

Alqahtani MF, Smith CM, Weiss SL, Dawson S, Ralay Ranaivo H, Wainwright MS - PLoS ONE (2016)

Receiver operating characteristic curves for biomarker discrimination between septic versus control febrile and healthy subjects.ROC curves for MMP-9/TIMP-1 ratio, mr-ProANP and A-FABP levels for (A) septic versus febrile subjects; (B) septic versus healthy subjects and (C) febrile versus healthy subjects. Triangle, A-FABP levels; Circle, mr-ProANP levels; Square, MMP-9/TIMP-1 ratio.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4835068&req=5

pone.0153645.g003: Receiver operating characteristic curves for biomarker discrimination between septic versus control febrile and healthy subjects.ROC curves for MMP-9/TIMP-1 ratio, mr-ProANP and A-FABP levels for (A) septic versus febrile subjects; (B) septic versus healthy subjects and (C) febrile versus healthy subjects. Triangle, A-FABP levels; Circle, mr-ProANP levels; Square, MMP-9/TIMP-1 ratio.
Mentions: The AUROC for MMP-9/TIMP-1 ratios on day 1 to discriminate septic patients from febrile controls was 0.86, (95% CI 0.74, 0.96), (Fig 3A) and from healthy controls was 0.96, (95% CI 0.91, 1.0 (both p<0.001) (Fig 3B). This ratio did not discriminate between febrile and healthy controls (0.52, 95% CI 0.34, 0.70) (Fig 3C). The MMP9/TIMP1 cut-point of < 0.36 yielded a sensitivity of 95% and specificity of 70% to diagnose sepsis.

Bottom Line: A-FaBP levels in septic patients with neurological dysfunction (29.3, 17.2-54.6, 7) were significantly increased compared to septic patients without neurological dysfunction (14.6, 13.3-20.6, 11).MMP-9/TIMP-1 ratios were significantly lower, while A-FaBP and mrProANP were higher in septic patients compared to the control groups.Each biomarker was associated with hospital morbidity and length of stay.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, Divisions of Critical Care, Ann & Robert. H. Lurie Children's Hospital of Chicago, Northwestern Feinberg School of Medicine, Chicago, Illinois, United States of America.

ABSTRACT
Elevated plasma concentrations of matrix metalloproteinase-9 (MMP-9), tissue inhibitor of metalloproteinase-1 (TIMP-1), mid-regional pro-atrial natriuretic peptide (mrProANP), and adipocyte fatty-acid-binding proteins (A-FaBPs) have been investigated as biomarkers for sepsis or detection of acute neurological injuries in adults, but not children. We carried out a single-center, prospective observational study to determine if these measures could serve as biomarkers to identify children with sepsis. A secondary aim was to determine if these biomarkers could identify children with neurologic complications of sepsis. A total of 90 patients ≤ 18 years-old were included in this study. 30 with severe sepsis or septic shock were compared to 30 age-matched febrile and 30 age-matched healthy controls. Serial measurements of each biomarker were obtained, beginning on day 1 of ICU admission. In septic patients, MMP9-/TIMP-1 ratios (Median, IQR, n) were reduced on day 1 (0.024, 0.004-0.174, 13), day 2 (0.020, 0.002-0.109, 10), and day 3 (0.018, 0.003-0.058, 23) compared with febrile (0.705, 0.187-1.778, 22) and healthy (0.7, 0.4-1.2, 29) (p< 0.05) controls. A-FaBP and mrProANP (Median, IQR ng/mL, n) were elevated in septic patients compared to control groups on first 2 days after admission to the PICU (p <0.05). The area under the curve (AUC) for MMP-9/TIMP-1 ratio, mrProANP, and A-FaBP to distinguish septic patients from healthy controls were 0.96, 0.99, and 0.76, respectively. MMP-9/TIMP-1 ratio was inversely and mrProANP was directly related to PIM-2, PELOD, and ICU and hospital LOS (p<0.05). A-FaBP level was associated with PELOD, hospital and ICU length of stay (p<0.05). MMP-9/TIMP-1 ratio associated with poor Glasgow Outcome Score (p<0.05). A-FaBP levels in septic patients with neurological dysfunction (29.3, 17.2-54.6, 7) were significantly increased compared to septic patients without neurological dysfunction (14.6, 13.3-20.6, 11). MMP-9/TIMP-1 ratios were significantly lower, while A-FaBP and mrProANP were higher in septic patients compared to the control groups. Each biomarker was associated with hospital morbidity and length of stay. These results suggest that these biomarkers merit further prospective study for the early identification of children with sepsis.

No MeSH data available.


Related in: MedlinePlus