Can resistin be a new indicator of neonatal sepsis?

Bioinformatic Analysis and Machine Learning Methods in Neonatal Sepsis: Identification of Biomarkers and Immune Infiltration

The disease neonatal sepsis (NS) poses a serious threat to life, and its pathogenesis remains unclear. Using the Gene Expression Omnibus (GEO) database, differentially expressed genes (DEGs) were identified and functional enrichment analyses were conducted. Three machine learning algorithms containing the least absolute shrinkage and selection operator (LASSO), support vector machine recursive feature elimination (SVM-RFE), and random forest (RF) were applied to identify the optimal feature genes (OFGs). This study conducted CIBERSORT to present the abundance of immune infiltrates between septic and control neonates and assessed the relationship between OFGs and immune cells. In total, 44 DEGs were discovered between the septic and control newborns. Throughout the enrichment analysis, DEGs were primarily related to inflammatory signaling pathways and immune responses. The OFGs derived from machine learning algorithms were intersected to yield four biomarkers, namely Hexokinase 3 (HK3), Cystatin 7 (CST7), Resistin (RETN), and Glycogenin 1 (GYG1). The potential biomarkers were validated in other datasets and LPS-stimulated HEUVCs. Septic infants showed a higher proportion of neutrophils (p < 0.001), M0 macrophages (p < 0.001), and regulatory T cells (p = 0.004). HK3, CST7, RETN, and GYG1 showed significant correlations with immune cells. Overall, the biomarkers offered promising insights into the molecular mechanisms of immune regulation for the prediction and treatment of NS.

Resistin Concentration in Early Sepsis and All-Cause Mortality at a Safety-Net Hospital in Riverside County

Background

Sepsis mortality has remained unchanged for greater than a decade, and early recognition continues to be the most important factor in mortality outcome. Plasma resistin concentration is increased in sepsis, but its mechanism and clinical relevance is unclear. As one function, resistin interacts with toll-like receptor 4 in competition with lipopolysaccharide, a main component of the gram-negative bacterial cell wall. It is not known if the type of infection leading to sepsis influences resistin production. The objective of this study was to investigate whether 1) early plasma resistin concentration can predict mortality, 2) elevated plasma resistin concentration is associated with clinical disease severity scores, such as SOFA, mSOFA and APACHE II, and 3) plasma resistin concentrations differ between gram negative versus other etiologies of sepsis.

Methods

This was an exploratory study in the framework of a prospective observational design. Peripheral venous blood samples were obtained from subjects admitted to the intensive care unit at clinical recognition of sepsis (0 hour) and at 6 and 24 hours. Vasopressor utilization was not a requirement for inclusion. Plasma was analyzed for resistin concentration by ELISA. Cytokine concentrations including IL-6, IL-8, and IL-10 were determined by cytokine bead array. Cytokine data were evaluated against publicly available sepsis RNA expression datasets to compare protein versus RNA expression levels in predicting clinical disease state. Clinical data were collected from electronic health records for clinical severity index calculations and context for interpretation of resistin and cytokine concentrations. Subjects were followed up to 60 days, or until death, whichever came first. Statistical analysis was completed with R package and SPSS software.

Results

Resistin levels were elevated in subjects admitted to the intensive care unit with sepsis. Four-hundred subjects were screened with 45 subjects included in the final analysis. Thirteen of 45 patients were non-survivors. Mortality within 60 days correlated with significantly higher resistin concentrations than in survivors. A resistin concentration of >126 ng/mL at clinical recognition of sepsis and >197 ng/mL within the first 24 hours were associated with mortality within 60 days with an area under the curve of 0.82 and 0.88, respectively. Most subjects with resistin concentration greater than these threshold values were deceased prior to 30 days. Resistin concentrations correlated with SOFA, mSOFA, and APACHE II scores in addition to having association with increases in inflammatory and sepsis biomarkers. These associations were validated with analysis of RNA expression datasets.

Conclusion

Plasma resistin concentrations of >126 ng/mL at clinical recognition of sepsis and >197 ng/mL within the first 24 hours of clinical sepsis recognition are associated with all-cause mortality. Resistin concentration within this timeframe also has comparable mortality association to well-validated clinical severity indices of SOFA, mSOFA, and APACHE II scores.

Resistin production does not affect outcomes in a mouse model of acute surgical sepsis

Introduction

Because of the strong correlation between the blood concentration of circulating resistin and the illness severity of septic patients, resistin has been proposed as a mediator of sepsis pathophysiology. In vitro data indicate that human resistin directly impairs neutrophil migration and intracellular bacterial killing, although the significance of these findings in vivo remain unclear.

Objective

The objectives of the present study were: (1) to validate the expression of human resistin in a clinically relevant, murine model of surgical sepsis, (2) to assess how sepsis-induced changes in resistin correlate with markers of infection and organ dysfunction, and (3) to investigate whether the expression of human resistin alters immune function or disease outcomes in vivo.

Methods

107 male, C57BL/6 mice transgenic for the human resistin gene and its promoter elements (Retn^+/−/−, or Retn+) were generated on a Retn^−/− (mouse resistin knockout, or Rko) background. Outcomes were compared between age-matched transgenic and knockout mice. Acute sepsis was defined as the initial 24 h following cecal ligation and puncture (CLP). Physiologic and laboratory parameters correlating to the human Sequential Organ Failure Assessment (SOFA) Score were measured in mice, and innate immune cell number/function in the blood and peritoneal cavity were assessed.

Results

CLP significantly increased circulating levels of human resistin. The severity of sepsis-induced leukopenia was comparable between Retn+ and Rko mice. Resistin was associated with increased production of neutrophil reactive oxygen species, a decrease in circulating neutrophils at 6 h and an increase in peritoneal Ly6C^hi monocytes at 6 h and 24 h post-sepsis. However, intraperitoneal bacterial growth, organ dysfunction and mouse survival did not differ with resistin production in septic mice.

Significance

Ex vivo resistin-induced impairment of neutrophil function do not appear to translate to increased sepsis severity or poorer outcomes in vivo following CLP.

Diagnosis of neonatal sepsis: the past, present and future

Sepsis remains a significant cause of neonatal mortality and morbidity, especially in low- and middle-income countries. Neonatal sepsis presents with nonspecific signs and symptoms that necessitate tests to confirm the diagnosis. Early and accurate diagnosis of infection will improve clinical outcomes and decrease the overuse of antibiotics. Current diagnostic methods rely on conventional culture methods, which is time-consuming, and may delay critical therapeutic decisions. Nonculture-based techniques including molecular methods and mass spectrometry may overcome some of the limitations seen with culture-based techniques. Biomarkers including hematological indices, cell adhesion molecules, interleukins, and acute-phase reactants have been used for the diagnosis of neonatal sepsis. In this review, we examine past and current microbiological techniques, hematological indices, and inflammatory biomarkers that may aid sepsis diagnosis. The search for an ideal biomarker that has adequate diagnostic accuracy early in sepsis is still ongoing. We discuss promising strategies for the future that are being developed and tested that may help us diagnose sepsis early and improve clinical outcomes. IMPACT: Reviews the clinical relevance of currently available diagnostic tests for sepsis. Summarizes the diagnostic accuracy of novel biomarkers for neonatal sepsis. Outlines future strategies including the use of omics technology, personalized medicine, and point of care tests.

Interleukin-6 as a Biomarker of Early-Onset Neonatal Sepsis

OBJECTIVE

The aim of this study is to determine the utility of C reactive protein (CRP) and interleukin (IL)-6 in the diagnosis of neonatal sepsis (NS) in a neonatal intensive care unit (NICU) in the south of Colombia.

STUDY DESIGN

A nonmatched case-control study was conducted. Convenience sampling was performed. Data were obtained from clinical records. IL-6 levels were determined using enzyme-linked immunosorbent assay. Receiver operator characteristic (ROC) curve analysis and Youden's index were used to determine the optimal cutoffs for CRP and IL-6 levels in diagnosing NS, early-onset NS (EONS), and late-onset NS (LONS).

RESULTS

Data from 31 cases and 62 controls were included. History of chorioamnionitis (infinite odds ratio [OR] [3.07-infinity]), and the presence of meconium-stained amniotic fluid during birth (OR: 9.04 [1.35-112]) were identified as risk factors for NS. Differences in CRP (p < 0.0001) and IL-6 (p < 0.0485) levels were also found, more significantly for LONS and EONS patients, respectively. In the diagnosis of LONS using CRP levels, the area under the ROC curve (AUC) was 0.8371 (p < 0.0001). The optimal cutoff was 0.53 mg/dL. For EONS diagnosis using IL-6, the AUC was 0.6869 (p = 0.0315) and the optimal cutoff was 17.75 pg/mL.

CONCLUSION

Differences between CRP and IL-6 levels were found between control and NS groups. Furthermore, CRP showed greater potential diagnostic utility in the LONS group, whereas IL-6 showed greater potential utility in the EONS group.

KEY POINTS

· NS is a major morbimortality cause worldwide. · CRP and IL-6 levels may be useful NS biomarkers. · No biomarker alone is enough for the diagnosis of NS.

Serum amyloid A - A prime candidate for identification of neonatal sepsis

Neonatal sepsis is common, lethal, and hard to diagnose. In combination with clinical findings and blood culture, biomarkers are crucial to make the correct diagnose. A Swedish national inquiry indicated that neonatologists were not quite satisfied with the available biomarkers. We assessed the kinetics of 15 biomarkers simultaneously: ferritin, fibrinogen, granulocyte colony-stimulating factor (G-CSF), interferon (IFN)-γ, interleukin (IL)-1β, -6, -8, -10, macrophage inflammatory protein (MIP)-1β, procalcitonin, resistin, serum amyloid A (SAA), tumor necrosis factor (TNF)-α, tissue plasminogen activator-3 and visfatin. The goal was to observe how quickly they rise in response to infection, and for how long they remain elevated. From a neonatal intensive care unit, newborns ≥28 weeks gestational age were recruited. Sixty-eight newborns were recruited to the study group (SG), and fifty-one to the control group (CG). The study group subjects were divided into three subgroups depending on clinical findings: confirmed sepsis (CSG), suspected sepsis (SSG) and no sepsis. CSG and SSG were also merged into an entire sepsis group (ESG) for sub-analysis. Blood samples were collected at three time-points; 0 h, 12-24 h and 48-72 h, in order to mimic a "clinical setting". At 0 h, visfatin was elevated in SSG compared to CG; G-CSF, IFN-γ, IL-1β, -8 and - 10 were elevated in SSG and ESG compared to CG, whereas IL-6 and SAA were elevated in all groups compared to CG. At 12-24 h, IL-8 was elevated in ESG compared to CG, visfatin was elevated in ESG and SSG compared to CG, and SAA was elevated in all three groups compared to CG. At 48-72 h, fibrinogen was elevated in ESG compared to CG, IFN-γ and IL-1β were elevated in SSG and ESG compared to CG, whereas IL-8 and SAA were elevated in all three groups compared to CG. A function of time-formula is introduced as a tool for theoretical prediction of biomarker levels at any time-point. We conclude that SAA has the most favorable kinetics regarding diagnosing neonatal sepsis, of the biomarkers studied. It is also readily available methodologically, making it a prime candidate for clinical use.

Relationship Between Resistin Levels and Sepsis Among Children Under 12 Years of Age: A Case Control Study

Objective: The aim of this study was to investigate the level of resistin in children with and without sepsis hospitalized in the pediatric intensive care unit (PICU) and compare them to levels in healthy subjects in order to determine the trend of resistin levels in children in PICUs and also to identify the cut-off values for positive sepsis. Methods: This was a case-control study conducted in 2014 at a children's hospital in Tabriz, Iran. Three groups were investigated, a case group comprised of patients with sepsis admitted to PICU and two control groups; one made up of patients admitted to PICU without sepsis and the other of healthy children. Variables included demographic, anthropometric (growth metric percentile), and clinical factors. Results: Patients were randomized into control group A (n = 12, 48%), control group B (n = 11, 44%), and the sepsis group (n = 24, 47.1%). The difference in the means of resistin levels was significant on the first, fourth, and seventh days (P < 0.0001) in the case and control group A. Means comparisons in the case and control group B revealed significant differences on the fourth and seventh day (P = 0.005 and P < 0.0001, respectively) but not on the first day (P = 0.246). The trend of resistin levels increased in the septic group (F Huynh-Feldt = 37.83, P < 0.0001). The diagnostic accuracy of resistin level was high for discriminating sepsis (area under the receiver operating characteristic curve [AUC] 0.864 [SE = 0.41]). The sensitivity was 0.824 and specificity 0.72 with a cut-off point of 5.2 ng/ml on the first day. Conclusion: In the present study, resistin level can be used as an indicator of sepsis in children admitted to PICU. However, the cut-off point based upon when a prediction could be made is different and is dependent on a variety of factors, such as control group and number of days since the first signs of sepsis.

Early diagnosis of necrotizing enterocolitis by plasma RELMβ and thrombocytopenia in preterm infants: A pilot study

BACKGROUND

As the inflammatory regulators, Resistin-like molecule β (RELMβ) and Resistin might be potential biomarkers of necrotizing enterocolitis (NEC), while thrombocytopenia is often related to the severity of NEC, clinical observation suggests that thrombocytopenia might be an early biomarker of NEC. The aim of this study was to evaluate whether RELMβ, Resistin and thrombocytopenia could be biomarkers for early diagnosis of NEC in preterm infants.

METHODS

From January 2016 to March 2018, twenty-nine NEC preterm infants who were diagnosed with NEC (Bell's stage ≥Ⅱ) by two independent neonatologists and twenty-nine non NEC preterm infants at neonatal intensive care unit in our hospital were enrolled in this case-control study. Preterm infants with a history of serious infections (sepsis, pneumonia), asphyxia, and congenital malformations were excluded from the study. The plasma RELMβ and Resistin were evaluated by enzyme linked immunosorbent assay (ELISA) and serum platelet levels were measured directly by ordinary light microscope at the diagnosis of NEC (Bell's stage ≥Ⅱ).

RESULTS

Plasma RELMβ levels in NEC group were significantly higher than control group (P < 0.05). The optimal cut-off value of RELMβ determined by receiver operating characteristic curve (ROC) was 378.3 ng/L. The overall estimates for sensitivity and specificity of high RELMβ concentrations in the detection of neonatal NEC were 71.4% and 91.7%, respectively. No significant difference was found in plasma Resistin levels between two groups (P > 0.05). If platelet level was less than 157 × 10⁹/L, the sensitivity and specificity were 69.34% and 82.87%, respectively. Interestingly, the combination of RELMβ and thrombocytopenia increased sensitivity and specificity to 82.89% and 93.21%, respectively.

CONCLUSION

The combination of RELMβ and thrombocytopenia was a reliable biomarker for the early diagnosis of NEC in this study with 82.89% sensitivity and 93.21% specificity, respectively.

C-reactive protein for diagnosing late-onset infection in newborn infants

BACKGROUND

Late-onset infection is the most common serious complication associated with hospital care for newborn infants. Because confirming the diagnosis by microbiological culture typically takes 24 to 48 hours, the serum level of the inflammatory marker C-reactive protein (CRP) measured as part of the initial investigation is used as an adjunctive rapid test to guide management in infants with suspected late-onset infection.

OBJECTIVES

To determine the diagnostic accuracy of serum CRP measurement in detecting late-onset infection in newborn infants.

SEARCH METHODS

We searched electronic databases (MEDLINE, Embase, and Science Citation Index to September 2017), conference proceedings, previous reviews, and the reference lists of retrieved articles.

SELECTION CRITERIA

We included cohort and cross-sectional studies evaluating the diagnostic accuracy of serum CRP levels for the detection of late-onset infection (occurring more than 72 hours after birth) in newborn infants.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed eligibility for inclusion, evaluated the methodological quality of included studies, and extracted data to estimate diagnostic accuracy using hierarchical summary receiver operating characteristic (SROC) models. We assessed heterogeneity by examining variability of study estimates and overlap of the 95% confidence interval (CI) in forest plots of sensitivity and specificity.

MAIN RESULTS

The search identified 20 studies (1615 infants). Most were small, single-centre, prospective cohort studies conducted in neonatal units in high- or middle-income countries since the late 1990s. Risk of bias in the included studies was generally low with independent assessment of index and reference tests. Most studies used a prespecified serum CRP threshold level as the definition of a 'positive' index test (typical cut-off level between 5 mg/L and 10 mg/L) and the culture of a pathogenic micro-organism from blood as the reference standard.At median specificity (0.74), sensitivity was 0.62 (95% CI 0.50 to 0.73). Heterogeneity was evident in the forest plots but it was not possible to conduct subgroup or meta-regression analyses by gestational ages, types of infection, or types of infecting micro-organism. Covariates for whether studies used a predefined threshold or not, and whether studies used a standard threshold of between 5 mg/L and 10 mg/L, were not statistically significant.

AUTHORS' CONCLUSIONS

The serum CRP level at initial evaluation of an infant with suspected late-onset infection is unlikely to be considered sufficiently accurate to aid early diagnosis or select infants to undergo further investigation or treatment with antimicrobial therapy or other interventions.

Utility of serum resistin in the diagnosis of neonatal sepsis and prediction of disease severity in term and late preterm infants

Introduction Resistin is a proinflammatory hormone recently proposed as a sepsis biomarker. Our aim was to evaluate the diagnostic and prognostic values of this marker in neonatal sepsis. Methods This is a prospective observational study that includes 60 term and late preterm neonates with proven and possible sepsis besides 30 healthy controls. Resistin and other biomarkers, like C-reactive protein (CRP), were measured within 2 h of neonatal intensive care unit (NICU) admission. Infants were monitored and the primary outcome was 30-day mortality. Results Resistin was higher among septic neonates compared with controls (P<0.001). Resistin had an area under the receiver operating characteristic (ROC) curve of 0.994 for differentiating septic infants from controls. The area under the curve (AUC) for differentiating infants with culture-proven sepsis from controls was 0.999 compared with an AUC of 1 for CRP. The other markers, like platelet count, were inferior to resistin and CRP. Resistin was positively correlated with CRP [Spearman's correlation coefficient (rs)=0.55, P<0.001]. No significant differences in resistin levels were noted between survivors and non-survivors but resistin was higher among infants with severe sepsis (P=0.015) and among those who needed mechanical ventilation (P<0.001). Conclusion Resistin is useful for the diagnosis of neonatal sepsis. Resistin failed to predict mortality but was associated with indicators of disease severity.

Mean platelet volume and serum uric acid in neonatal sepsis: A case-control study

Background

Mean platelet volume (MPV) is a measure of platelet volume. It reveals the presence of inflammatory burden and disease activity in many diseases. Serum uric acid (SUA) is one of the most important antioxidants in human biological fluids and is responsible for neutralizing > 50% of the free radicals in the human blood. For this reason, it was thought that the antioxidant effects of SUA could increase the life expectancy and/or reduce the incidence of malignancy.

Objectives

To determine the role of mean platelet volume (MPV) and serum uric acid (SUA) level in the diagnosis of neonatal sepsis (NS).

Methods

This case-control study was done on 80 newborns divided into 3 groups: group A (n = 22): clinical NS, group B (n = 18): Proven NS and Group C (n = 40): apparently healthy control. All patients in the study were subjected to adequate assessment of history, full clinical examination, complete blood count including MPV, C - reactive protein (CRP), blood culture in CRP positive cases, and SUA level at the time of diagnosis of sepsis.

Results

Septic neonates showed statistically higher values of MPV and statistically lower levels of SUA than the control group. The diagnostic cut-off values of MPV and SUA for NS were 10.2 fL, and 3.70 mg/dL, respectively.

Conclusions

MPV could be assessed in the early diagnosis of neonatal sepsis while SUA level has lower sensitivity in neonatal sepsis.

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Mean platelet volume (MPV) reveals the presence of inflammatory burden and disease activity in many diseases. Serum uric acid (SUA) is one of the most important antioxidants in human biological fluids.

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Serum uric acid cutoff point was 3.7 mg/dl, sensitivity was 13%, specificity was 19%, positive predictive value was 19%, negative predictive value was 13% and diagnostic accuracy was 15%.

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This study revealed that MPV showed a statistically significant positive correlation with WBCs and CRP, and a statistically significant negative correlation with gestational age, birth weight and platelet count.

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Cutoff point of MPV was 10.2 fl, sensitivity was 71%, specificity was 63%, positive predictive value was 74%, negative predictive value was 59% and diagnostic accuracy was 68% SUA showed a statistically significant positive correlation with gestational age and birth weight, and significant negative correlation with CRP.

Cytokine profiles in patients with toxoplasmic lymphadenitis in the setting of pregnancy

INTRODUCTION

Majority of Toxoplasma gondii infections are benign and asymptomatic; however, some patients experience toxoplasmic lymphadenitis (TL). Factors associated as to whether infection will be symptomatic or not are unknown.

METHODS

Dye test titers of patients with acute toxoplasmosis (pregnant and not pregnant) with TL (TL+) were compared with those in patients with asymptomatic acute infection (TL-). Additionally, mean levels of 62 serum cytokines were compared between TL+ and TL- pregnant women and between TL+ pregnant and non-pregnant women.

RESULTS

During acute infection, mean dye test titer was higher in TL+ than in TL- patients (p=0.021). In addition, out of 62 cytokines, CXCL9andCXCL10 levels were higher (p<0.05) and resistin mean levels were lower (p<0.05) in pregnant women with TL+ compared to TL-. Among patients with TL+, levels of VCAM1andCCL2 were lower (p<0.05) in pregnant women than in non-pregnant women.

CONCLUSION

Here we report differences in dye test titers in patients with acute infection. Cytokine responses vary according to the presence of TL+ and to the pregnancy status. Factors underlying these differences are presently unknown and require further studies to define individual and combined roles of cytokines in TL+.

Clinical potential of resistin as a novel prognostic biomarker for cellulitis

Cellulitis is an acute, subacute or chronic inflammation of the dermis and subdermal tissues, which is typically caused by bacteria, although other causes are possible. The present study aimed to evaluate the association between resistin levels and the recovery time of patients with cellulitis. In addition, the effect of resistin and insulin resistance on the prognosis of cellulitis was investigated. In total, 52 patients with cellulitis (male, 21; female, 31) and an age-matched group of 42 healthy individuals (male, 18; female, 24) were included in the study. The levels of serum resistin, fasting plasma glucose (FPG), homeostasis model assessment-insulin resistance (HOMA-IR), C-reactive protein (CRP) and other biochemical parameters were compared between the groups. The mean resistin levels in the cellulitis and control groups were 9.4±5.3 and 5.8±3.1 ng/ml, respectively. The levels of resistin, FPG, HOMA-IR and CRP were significantly higher in the cellulitis group compared with the control group (P<0.001). Furthermore, the mean recovery time of the patients with cellulitis was 21.2±5.6 days. Thus, increased levels of resistin (P=0.002) and HOMA-IR (P=0.005) could be used as predictive factors for the recovery time. The enhanced levels of resistin and HOMA-IR were shown to correlate with the high CRP levels in the cellulitis group. Therefore, the results indicated that increased levels of resistin may function as a prognostic marker for cellulitis.

Postnatal Age Is a Critical Determinant of the Neonatal Host Response to Sepsis

Neonates manifest a unique host response to sepsis even among other children. Preterm neonates may experience sepsis soon after birth or during often-protracted birth hospitalizations as they attain physiologic maturity. We examined the transcriptome using genome-wide expression profiling on prospectively collected peripheral blood samples from infants evaluated for sepsis within 24 h after clinical presentation. Simultaneous plasma samples were examined for alterations in inflammatory mediators. Group designation (sepsis or uninfected) was determined retrospectively on the basis of clinical exam and laboratory results over the next 72 h from the time of evaluation. Unsupervised analysis showed the major node of separation between groups was timing of sepsis episode relative to birth (early, <3 d, or late, ≥3 d). Principal component analyses revealed significant differences between patients with early or late sepsis despite the presence of similar key immunologic pathway aberrations in both groups. Unique to neonates, the uninfected state and host response to sepsis is significantly affected by timing relative to birth. Future therapeutic approaches may need to be tailored to the timing of the infectious event based on postnatal age.

Clinical potential of resistin as a novel prognostic biomarker for cellulitis

Cellulitis is an acute, subacute or chronic inflammation of the dermis and subdermal tissues, which is typically caused by bacteria, although other causes are possible. The present study aimed to evaluate the association between resistin levels and the recovery time of patients with cellulitis. In addition, the effect of resistin and insulin resistance on the prognosis of cellulitis was investigated. In total, 52 patients with cellulitis (male, 21; female, 31) and an age-matched group of 42 healthy individuals (male, 18; female, 24) were included in the study. The levels of serum resistin, fasting plasma glucose (FPG), homeostasis model assessment-insulin resistance (HOMA-IR), C-reactive protein (CRP) and other biochemical parameters were compared between the groups. The mean resistin levels in the cellulitis and control groups were 9.4±5.3 and 5.8±3.1 ng/ml, respectively. The levels of resistin, FPG, HOMA-IR and CRP were significantly higher in the cellulitis group compared with the control group (P<0.001). Furthermore, the mean recovery time of the patients with cellulitis was 21.2±5.6 days. Thus, increased levels of resistin (P=0.002) and HOMA-IR (P=0.005) could be used as predictive factors for the recovery time. The enhanced levels of resistin and HOMA-IR were shown to correlate with the high CRP levels in the cellulitis group. Therefore, the results indicated that increased levels of resistin may function as a prognostic marker for cellulitis.

Increased Resistin Levels in Intra-abdominal Sepsis: Correlation with proinflammatory cytokines and Acute Physiology and Chronic Health Evaluation (APACHE) II scores

OBJECTIVES

Resistin, a hormone secreted from adipocytes and considered to be a likely cause of insulin resistance, has recently been accepted as a proinflammatory cytokine. This study aimed to determine the correlation between resistin levels in patients with intra-abdominal sepsis and mortality.

METHODS

Of 45 patients with intra-abdominal sepsis, a total of 35 adult patients were included in the study. This study was undertaken from December 2011 to December 2012 and included patients who had no history of diabetes mellitus and who were admitted to the general surgery intensive care units of Gazi University and Bülent Ecevit University School of Medicine, Turkey. Evaluations were performed on 12 patients with sepsis, 10 patients with severe sepsis, 13 patients with septic shock and 15 healthy controls. The patients' plasma resistin, interleukin-6 (IL-6), tumour necrosis factor alpha (TNF-α), interleukin-1 beta (IL-1β), procalcitonin, lactate and glucose levels and Acute Physiology and Chronic Health Evaluation (APACHE) II scores were studied daily for the first five days after admission. A correlation analysis of serum resistin levels with cytokine levels and APACHE II scores was performed.

RESULTS

Serum resistin levels in patients with sepsis were significantly higher than in the healthy controls (P <0.001). A significant correlation was found between serum resistin levels and APACHE II scores, serum IL-6, IL-1β, TNF-α, procalcitonin, lactate and glucose levels. Furthermore, a significant correlation was found between serum resistin levels and all-cause mortality (P = 0.02).

CONCLUSION

The levels of resistin were significantly positively correlated with the severity of disease and were a possible mediator of a prolonged inflammatory state in patients with intra-abdominal sepsis.

Serum resistin levels may be new prognostic factor of crimean-congo hemorrhagic fever

Crimean-Congo hemorrhagic fever (CCHF) virus can cause potentially fatal infections in humans. During this disease, cytokines are intensive released. Resistin which is a good marker of inflammation is an adipocytokine released from adipose tissue. We aimed to investigate whether serum resistin level in patients with CCHF has a prognostic value in predicting recovery time. Twenty men and 22 women (a total of 42 CCHF patients) and a similar age group of 40 healthy individuals (16 men and 24 women) were included in the study. Hematologic tests, serum resistin level, C-reactive protein (CRP) and others biochemical values of all the two group subjects were evaluated. Multivariate logistic regression analysis was performed. Resistin level of patients with CCHF was higher than the controls (1252.6±864.7 ng/ml vs. 824.1±224.6 ng/ml, p=0.003). There was strongly association among recovery time, increased resistin level (p < 0.001), prothrombin time (PT) (p < 0.001), INR (p < 0.001), decreased white blood cell count (WBC) (p=0.012) and lower platelet counts (p=0.007). Serum resistin level is significantly elevated in CCHF patients. Resistin level may be a good prognostic factor to predict recovery time in patients with CCHF.