Study on the Usefulness of APR Scores from the Viewpoint of Proinflammatory Cytokines

Abstract

Background. Delayed diagnosis and treatment of newborn infection adversely impact outcomes. Clinical laboratory parameters have aimed to obtain the most correct and prompt diagnosis and treatment of this disease. This study simultaneously observed changes over time in APR as well as proinflammatory cytokines and anti-proinflammatory cytokines and aims to clarify usefulness of APR scores. Methods. We evaluated the usefulness of acute phase reactants (APR) in 46 newborns whose serum up to age 7 days had been stored, with comparison of three types (Group I: infection 15, Group F: fetal inflammatory response syndrome 17, and Group C: control 14) of APR-based scores, those of C-reactive protein (CRP), alpha1-acid glycoprotein (AGP), and haptoglobin (Hp), with proinflammatory cytokine levels. APR scores for CRP, AGP, and Hp and the levels of the proinflammatory cytokines IL-1β, IL-6, IL-8, IL-10, and TNFα were determined. Results. The cytokine levels started to increase from age 0 days and then decreased rapidly. The three APR scores, CRP, AG, and Hp, were elevated at age 0 days and then gradually decreased in infection (Group I) and fetal inflammatory response syndrome (Group F). The duration of antibiotic administration according to APR scores was significantly shorter in Group F than in Group I. Conclusion. This study demonstrated APR scores to be more useful for deciding whether antibiotics should be discontinued than proinflammatory cytokine levels.

Evidence of both foetal inflammation and hypoxia–ischaemia is associated with meconium aspiration syndrome

“…An increase in α 1 -AG serum level is associated with various conditions, including cancer, trauma, infection, and inflammation 29 . Simultaneous α 1 -AG and haptoglobin measurement, in addition to CRP, has been proposed for the early detection of systemic infection in neonates [30][31][32] . CRP levels tend to rise shortly after birth in neonates with MAS, potentially in response to chemical pneumonitis, mechanical ventilation, bacterial superinfection, and airway obstruction [33][34][35] .…”

Influence of foetal inflammation on the development of meconium aspiration syndrome in term neonates with meconium-stained amniotic fluid

“…Foetal ingestion of amniotic fluid containing inflammatory mediators may ultimately induce the meconium passage into the amniotic fluid. Although our study did not measure inflammatory cytokine levels, three inflammatory biomarkers, CRP, α 1 AG, and haptoglobin, were employed, which are produced in the liver in response to intrinsic/extrinsic stimuli and subsequent elevation of IL-1ß and IL-6 (Ipek, Saracoglu & Bozaykut, 2010; Nakamura et al, 2015). Although these inflammatory biomarkers and their composite scores were not involved within the final model to explain the development of MAS, there was a consistent trend that an increase in inflammatory biomarkers was associated with relatively higher incidence of MAS.…”

“…For the inflammatory markers, C-reactive protein (CRP), α 1 -acid glycoprotein (α 1 AG), and haptoglobin were measured using turbidimetric immunoassay (Quick Turbo; Shino-Test Corporation, Tokyo, Japan). CRP > 0.3 mg/dl, α 1 AG > 20 mg/dl, and haptoglobin > 13 mg/dl were regarded as positive (Speer, Bruns & Gahr, 1983; Ipek, Saracoglu & Bozaykut, 2010; Nakamura et al, 2015); the acute-phase inflammatory reaction scores of 0 (none positive), 1 (one positive biomarker), 2 (two positive biomarkers), and 3 (all three positive biomarkers) were given based on the number of positive inflammatory biomarkers (Nakamura et al, 2015). Venous blood culture was assessed for neonates with clinical signs suggestive of antenatal infection (e.g., elevation of maternal white blood cell count and CRP, maternal pyrexia, and premature rupture of the membranes) or with the acute-phase inflammatory reaction scores ≥1.…”

Peer Review #2 of "Influence of foetal inflammation on the development of meconium aspiration syndrome in term neonates with meconium-stained amniotic fluid (v0.1)"

“…Foetal ingestion of amniotic fluid containing inflammatory mediators may ultimately induce the meconium passage into the amniotic fluid. Although our study did not measure inflammatory cytokine levels, three inflammatory biomarkers, CRP, α 1 AG, and haptoglobin, were employed, which are produced in the liver in response to intrinsic/extrinsic stimuli and subsequent elevation of IL-1ß and IL-6 (Ipek et al, 2010;Nakamura et al, 2015).…”

“…For the inflammatory markers, C-reactive protein (CRP), α 1 -acid glycoprotein (α 1 AG), and haptoglobin were measured using turbidimetric immunoassay (Quick Turbo, Shino-Test Corporation, Japan). CRP >0.3 mg/dL, α 1 AG >20 mg/dL, and haptoglobin >13 mg/dl were regarded as positive (Speer et al, 1983;Ipek et al, 2010;Nakamura et al, 2015); the acute-phase inflammatory reaction scores of 0 (none positive), 1 (one positive biomarker), 2 (two positive biomarkers) and 3 (all three positive biomarkers) were given based on the number of positive inflammatory biomarkers (Nakamura et al, 2015). Venous blood culture was assessed for neonates with clinical signs suggestive of antenatal infection (e.g.…”