Early Inflammatory Markers for Prediction of Cholestasis in Very-Low-Birth-Weight Infants

DeMauro, Sara B.; Kilpatrick, Laurie E.; Gerdes, Jeffrey S.; Abbasi, Soraya

doi:10.1159/000339960

Cited by 7 publications

(10 citation statements)

References 50 publications

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“…The authors concluded that CRP was strongly associated with liver injury and might be used as a useful marker for the prediction of PNAC. 10 In this present study, increased CRP levels were determined in infants with cholestasis, however it was not statistically significant. Therefore, our results were in accordance with the findings of DeMauro et al 10 .…”

Section: Discussioncontrasting

confidence: 67%

“…These cytokines have been suggested to lead to cholestasis by downregulation of bile flow. 10,27 DeMauro et al 10 investigated the role of CRP and some inflammatory cytokines for predicting PNAC in very low birth weight infants. The predictive value of these cytokines and CRP were evaluated at the 2 nd , 4 th and 6 th weeks of PN administration.…”

Section: Discussionmentioning

confidence: 99%

“…Plasma cytokine and C-reactive protein (CRP) levels were reported to have predictive value for determination of PNAC in very low birth weight (VLBW) infants. 10 Procalcitonin (PCT), the precursor protein of calcitonin, produced by monocytes and hepatocytes. It has been reported as a strong biomarker for infection and inflammation with higher sensitivity and specificity compared to CRP, especially for neonatal sepsis.…”

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confidence: 99%

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The effectiveness of serum amyloid A for prediction of neonatal cholestasis associated with parenteral nutrition in premature infants

et al. 2019

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Özkan H, Köksal N, Doğan P, Güney-Varal İ, Bağcı O, Özgür T. The effectiveness of serum amyloid A for prediction of neonatal cholestasis associated with parenteral nutrition in premature infants. Turk J Pediatr 2019; 61: 26-33.Parenteral nutrition (PN) has been widely used in premature infants untill enteral feeding can be tolerated. Cholestasis is an important complication of PN. The objective of this study was to evaluate the role of serial measurements of serum amyloid A (SAA) during PN and compare its' effectiveness with C-reactive protein (CRP) and procalcitonin (PCT). We also aimed to determine the risk factors for PN associated cholestasis (PNAC).Premature infants (<34 weeks' gestational age) who were started on PN during hospitalization were included in this prospective study. SAA, CRP and PCT levels were measured on days 0, 3, 7, 14, and 21 of PN in all infants. Infants who had PN for less than 2 weeks, who developed sepsis and/or necrotizing enterocolitis were excluded.A total of 85 infants were included. The mean birth weight was 1226±329 g, and the mean gestational age was 29.4±1.8 weeks. The birth weight of infants who developed cholestasis were significantly lower. Enteral nutrition was started significantly later in infants with cholestasis. CRP and PCT did not correlate with conjugated bilirubin levels at any time point. SAA levels on days 7 and 14 showed a significant correlation with conjugated bilirubin levels. SAA levels on day 7 was found to have the highest sensitivity for prediction of PNAC.Low birth weight, late commencement of enteral feeding, and prolonged PN were the main risk factors for PNAC development. This is the first study that shows the predictive value of SAA for PNAC development. We suggest that SAA may be used as an accurate and useful biomarker for prediction of PNAC in high risk premature infants receiving PN.

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Section: Discussioncontrasting

confidence: 67%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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The effectiveness of serum amyloid A for prediction of neonatal cholestasis associated with parenteral nutrition in premature infants

et al. 2019

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“…In addition, we also indicated serum FGF19 concentrations were inversely associated with pro-inflammatory cytokine IL-6. IL-6 has been previously reported to involved in cholestasis among infants and children with intrahepatic and extrahepatic cholestasis29. The intestinal injury in IF patients could cause terminal ileum epithelial cells damaged and reduced the terminal ileum FXR expression.…”

Section: Discussionmentioning

confidence: 99%

Altered systemic bile acid homeostasis contributes to liver disease in pediatric patients with intestinal failure

Xiao

Cao

Zhou

et al. 2016

Sci Rep

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Intestinal failure (IF)-associated liver disease (IFALD), as a major complication, contributes to significant morbidity in pediatric IF patients. However, the pathogenesis of IFALD is still uncertain. We here investigate the roles of bile acid (BA) dysmetabolism in the unclear pathogenesis of IFALD. It found that the histological evidence of pediatric IF patients exhibited liver injury, which was characterized by liver bile duct proliferation, inflammatory infiltration, hepatocyte apoptosis and different stages of fibrosis. The BA compositions were altered in serum and liver of pediatric IF patients, as reflected by a primary BA dominant composition. In IF patients, the serum FGF19 levels decreased significantly, and were conversely correlated with ileal inflammation grades (r = −0.50, p < 0.05). In ileum, the inflammation grades were inversely associated with farnesoid X receptor (FXR) expression (r = −0.55, p < 0.05). In liver, the expression of induction of the rate-limiting enzyme in bile salt synthesis, cytochrome P450 7a1 (CYP7A1) increased evidently. In conclusion, ileum inflammation decreases FXR expression corresponding to reduce serum FGF19 concentration, along with increased hepatic bile acid synthesis, leading to liver damages in IF patients.

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“…For example, it was recently shown that BAs promote hepatic inflammation involving MIP‐1α and IL‐8 . Furthermore, CRP is used as an early marker for liver injury and cholestasis . Moreover, BAs appear to induce the production of the inflammatory markers IL‐6 and IL‐8 in the airway epithelium .…”

Section: Discussionmentioning

confidence: 99%

MAIT cell activation in adolescents is impacted by bile acid concentrations and body weight

Mendler

Pierzchalski

Bauer

et al. 2020

Clinical and Experimental Immunology

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Bile acids (BAs) are produced by liver hepatocytes and were recently shown to exert functions additional to their well-known role in lipid digestion. As yet it is not known whether the mucosal-associated invariant T (MAIT) cells, which represent 10-15% of the hepatic T cell population, are affected by BAs. The focus of the present investigation was on the association of BA serum concentration with MAIT cell function and inflammatory parameters as well as on the relationship of these parameters to body weight. Blood samples from 41 normal weight and 41 overweight children of the Lifestyle Immune System Allergy (LISA) study were analyzed with respect to MAIT cell surface and activation markers [CD107a, CD137, CD69, interferon (IFN)-γ, tumor necrosis factor (TNF)-α] after Escherichia coli stimulation, mRNA expression of promyelocytic leukemia zinc finger protein (PLZF) and major histocompatibility complex class I-related gene protein (MR1), the inflammatory markers C-reactive protein (CRP), interleukin (IL)-8 and macrophage inflammatory protein (MIP)-1α as well as the concentrations of 13 conjugated and unconjugated BAs. Higher body weight was associated with reduced MAIT cell activation and expression of natural killer cell marker (NKp80) and chemokine receptor (CXCR3). BA concentrations were positively associated with the inflammatory parameters CRP, IL-8 and MIP-1α, but were negatively associated with the number of activated MAIT cells and the MAIT cell transcription factor PLZF. These relationships were exclusively found with conjugated BAs. BA-mediated inhibition of MAIT cell activation was confirmed in vitro. Thus, conjugated BAs have the capacity to modulate the balance between pro-and anti-inflammatory immune responses.

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Early Inflammatory Markers for Prediction of Cholestasis in Very-Low-Birth-Weight Infants

Cited by 7 publications

References 50 publications

The effectiveness of serum amyloid A for prediction of neonatal cholestasis associated with parenteral nutrition in premature infants

The effectiveness of serum amyloid A for prediction of neonatal cholestasis associated with parenteral nutrition in premature infants

Altered systemic bile acid homeostasis contributes to liver disease in pediatric patients with intestinal failure

MAIT cell activation in adolescents is impacted by bile acid concentrations and body weight

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