To Determine The Association Of Serum Neopterin Levels In Sepsis

Abstract

Background: Sepsis is a leading cause of death worldwide. Sepsis results in state of multiorgan dysfunction in the body. Early identification and appropriate treatment is the key in sepsis management. Many biomarkers have been studied in sepsis. Serum Neopterin is a biomarker, synthesised by human macrophages upon stimulation with the cytokine interferon-gamma(INF-γ) and is indicative of a pro-inflammatory immune status. Since neopterin is an indirect measure of T cell activation, it could be a useful tool in evaluation of clinical course in septic patients. Methods It is a case control study conducted in Amrita Institute of Medical sciences.Patients were categorised into 3 groups: Sepsis with MODS (Group 1, n=22), Sepsis Non MODS(Group 2 , n=17), and Non sepsis (Group 3, n=16). Serum Neopterin levels and along other markers like CRP, Procalcitonin, ESR and Total counts were taken from the 3 groups of patients at 0, 48 and 96 hours. RESULTS Data was analysed using SPSS statistics. The median Neopterin Levels performed at 48 hours were compared between Sepsis Group and Non-Sepsis patients. The median Neopterin levels in sepsis group was 87.00 (40.00,129.00) and in non-sepsis groups was 22.00(12.00, 39.00) and p value obtained was <0.001, hence neopterin is significant marker in diagnosing sepsis. The median levels were then compared between group 1 and group 2. The median values in sepsis with MODS was 123.00(79.25, 146.00) and in sepsis without MODS was 54.00(34.00, 88.50) and the p value obtained was 0.001. Hence Neopterin is significant marker in diagnosing patients with MODS in patients with sepsis. Serum Neopterin had sensitivity of 92.31%, specificity of 100% and accuracy of 94.55 % in predicting sepsis. In predicting MODS, its sensitivity was 92.31%, specificity was 100% and accuracy was 94.55%. It also showed good correlation with SOFA, qSOFA and APACHE scores. Conclusion Serum Neopterin is a marker which can help in diagnosing sepsis and can also be a useful marker in differentiating patients with MODS from patients without MODS. Neopterin has showed that it is better marker in identifying MODS in patients with sepsis than Procalcitonin, ESR and total counts. The levels of Neopterin also correlated with the severity of sepsis and showed a good relation with SOFA, APACHE and Qsofa scores. The dynamic measurements of neopterin are predictive of the clinical status of the patient. Hence Serum Neopterin is a good marker to diagnose sepsis and also a good marker to prognosticate sepsis.