Pilot Trial Evaluating Mid-Regional Pro-Atrial Natriuretic Peptide as a Marker of Sepsis after Abdominal Surgery
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Hellenic Journal of Surgery (2018) 90:5, 232-238
Pilot Trial Evaluating Mid-Regional Pro-Atrial Natriuretic Peptide as a Marker of Sepsis after Abdominal Surgery Kousoulas L, Fink JM, Glatz T, Läßle C, Bohlmann IJ, Fichtner-Feigl S, Utzolino S
Abstract Introduction: Mid-regional pro-atrial natriuretic peptide (MR pro-ANP) has been shown to be a diagnostic marker
for sepsis. The objective of this pilot study was to evaluate the potential of MR pro-ANP in the diagnosis of postoperative sepsis. Methods: We enrolled 18 patients with postoperative sepsis, 19 patients who underwent major abdominal surgery without sepsis and 9 healthy individuals as control subjects. MR pro-ANP, interleukin-6 (IL-6) and procalcitonin (PCT) were measured on the day of inclusion in the study, and at days 3, 7 and 10. Results: The mean levels of MR pro-ANP were significantly higher in patients with postoperative sepsis than in patients without sepsis (two-way ANOVA p 38° Celsius (°C) or < 36°C; 2) heart rate > 90 beats per minute; 3) respiratory rate > 20 breaths per minute or PaC02 < 32 mmHg; 4) leukocyte count > 12,000/mm3 or < 4,000/mm3; 5) organ failure. All the subjects in group 1 were included in the study within 24 hours of onset of septic symptoms. Group 2 (postoperative patients) consisted of patients who had undergone major abdominal surgery and showed no signs of sepsis. They were enrolled on the first postoperative day. Patients with pancreatitis and those who had undergone hepatic resection were excluded. Group 3 (healthy individuals) consisted of healthy individuals who had not undergone operation. The study was approved by the hospital Ethics Committee. Data recording and evaluation was conducted in accordance with the Declaration of Helsinki. Written informed consent was obtained from all participants. In order to exclude potential bias, the laboratory personnel analyzing MR pro-ANP received no clinical information on the study subjects. Study protocol
After inclusion in the study, venous blood samples from the patients in groups 1 and 2 were taken at 4 time points over a period of 10 days. The first sample was drawn as soon as the patient presented symptoms of postoperative sepsis (group 1) or on the first postoperative day (group 2), and subsequent samples on days 3, 7 and 10. A single blood sample was drawn from each healthy control subject (group 3) at one arbitrary point in time. At each sampling time point, measurement was made of MR pro-ANP, IL-6 and PCT, and the leukocyte count was recorded. Hellenic Journal of Surgery 90
Assays for MR pro-ANP, PCT and IL-6
At each time point, 1 EDTA, 1 citrate and 1 heparin tube were taken. The citrate and heparin tubes were centrifuged at 3,000 g at 4 °C for 10 minutes. The serum was then stored at -24 °C for later analysis. Cytokines were measured using commercial Enzymelinked Immuno-absorbent Assay Kits (ELISA). Il- 6 was measured with Immulite-System 2000 (Random Access Immunoassay Analyzer, DPC Biermann, Germany). The plasma level of PCT was measured with the Liason® Analy
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