Paraoxonase-1 activities and procalcitonin levels in sepsis and non-infectious systemic inflammatory response syndrome patients in the intensive care unit setting of Tengku Ampuan Afzan Hospital Kuantan /
Despite advances in medicine and improved access to healthcare, sepsis remains to be a leading cause of death in the intensive care unit (ICU), including in Malaysia. Distinguishing early sepsis from non-infectious systemic inflammatory response syndrome (SIRS) may be difficult upon presentation. Th...
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| Main Author: | |
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| Format: | Thesis |
| Language: | English |
| Published: |
Kuantan, Pahang :
Kulliyyah of Medicine, International Islamic University Malaysia,
2017
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| Subjects: | |
| Online Access: | Click here to view 1st 24 pages of the thesis. Members can view fulltext at the specified PCs in the library. |
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| Summary: | Despite advances in medicine and improved access to healthcare, sepsis remains to be a leading cause of death in the intensive care unit (ICU), including in Malaysia. Distinguishing early sepsis from non-infectious systemic inflammatory response syndrome (SIRS) may be difficult upon presentation. Thus, research has been ongoing in finding a specific and effective marker for sepsis, where paraoxonase-1 (PON1) has shown to be a promising contender. PON1 is a high density lipoprotein associated enzyme, where early researches have shown that its activities decrease as oxidative stress increases in intensity during sepsis. Aim: This study aimed to compare PON1 activities between sepsis and non-infectious SIRS patients, as well as comparing its activities in patients who ultimately survived or died as a result of their ordeal. In addition, this study looked into the diagnostic and predictive performance of PON1 for sepsis and mortality as well as the correlation between PON1 activities and a known sepsis marker, procalcitonin (PCT). Methodology: This prospective observational study, recruited ICU patients above the age of 18 with SIRS and divided them into sepsis and non-infectious SIRS based on clinical assessment with or without positive cultures. PON1 activities; paraoxonase (PON) and arylesterase (ARE) activities, and PCT levels were measured daily over the first three days of ICU admission. Results: Out of the 239 patients recruited, 164 (69%) had sepsis and 68 (28.5%) died in hospital. Results showed significantly lower PON1 activities in sepsis compared to non-infectious SIRS throughout the three-day period [PON Day 1: 142.2 (85.7-205) vs. 171.7 (124-294.1), p<0.0001; Day 2: 128.2 (78.4-197) vs. 176.3 (116.5-284), p=0.001; Day 3: 112.1 (68-171.5) vs. 156 (106-266.7), p=0.005; ARE Day 1: 71.1 (48.8-91.8) vs. 93.7 (63.8-118), p<0.0001; Day 2: 69.4 (42.5-98.8) vs. 101.7 (69.3-117.9), p<0.0001; Day 3: 66.5 (41.5-96) vs. 95.4 (70.4-111.1), p=0.001]. PON1 activities were also significantly lower in non-survivors compared to the survivors [PON Day 1: 114.6 (81-186.4) vs. 162.5 (102-252), p=0.002; Day 2: 101.8 (65-193.7) vs. 152.5 (100-238), p=0.002; Day 3: 106.2 (58.1-151.3) vs. 128.5 (79.2-228), p=0.025; ARE Day 1: 64.9 (39.4-89.7) vs. 80.9 (60-108.3), p=0.001; Day 2: 58.2 (40.6-94.2) vs. 82.8 (55-115.5), p=0.003; Day 3: 61.1 (36.8-98) vs. 80.8 (49.8-109), p=0.010]. Further analysis also showed that ARE activity to be a slightly better detector of sepsis than PON activity (PON AUC 0.64-0.65 versus ARE AUC 0.67-0.69), but similar in power in predicting mortality (ARE AUC 0.61-0.64, PON AUC 0.62-0.64). PON1 activities and PCT levels were all significantly correlated with weak to moderate correlation with r-values between 0.207-0.476. Conclusion: PON1 activity measured early on ICU admission has a big potential to be a biomarker in distinguishing sepsis from non-infectious SIRS and in prediction of mortality. A larger scale study, involving multiple centres around Malaysia could be done to further confirm these findings. Keywords: Paraoxonase-1, sepsis, SIRS, diagnosis, ICU |
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| Item Description: | Abstracts in English and Arabic. "A thesis submitted in fulfilment of the requirement for the degree of Master of Medical Sciences." --On title page. |
| Physical Description: | xii, 72 leaves : colour illustrations ; 30cm. |
| Bibliography: | Includes bibliographical references (leaves 57-64). |