الفهرس 
SepsisOnly 14 pages are availabe for public view
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Abstract
Pediatric sepsis is a serious public health concern with
incidence, morbidity, and mortality rates that are comparable to those
of critically ill adult populations. Severe sepsis accounts for >8% of
all critically ill children every year and causes >4.5 million children’s
deaths worldwide.
As a consequence of sepsis, numerous biomarkers are
generated, and more than 250 distinct biomarkers have been
investigated in clinical settings with varying degrees of efficacy.
Despite the fact that no single biomarker has been proven to be a good
predictor of sepsis, rapid recognition of significant biomarkers may
provide useful diagnostic and prognostic data.
Arginine vasopressin (AVP) one of the main hormonal
components of the hypothalamic-pituitary-adrenal axis that regulates
fluid homeostasis, vasoconstriction, and the endocrine stress response.
Additionally, AVP levels could increase in several illness conditions,
including sepsis, AVP-dependent disorders, and acute myocardial
infarction.
Copeptin derives from the same precursor peptide
preprovasopressin as arginine vasopressin (AVP). Copeptin is a 39-
amino acid glycosylated peptide that constitutes the C-terminal
portion of preprovasopressin c,and coreleased with AVP. In response
to osmotic, hemodynamic stimulation, and pathological conditions,
Copeptin is a preferred sensitive and stable surrogate biomarker for
estimating AVP release due to the short half-life and instability of
AVP in blood.
Summary
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In this study we aim to assess reliability of copeptin as a
diagnostic and prognostic biomarker of sepsis in Pediatric Intensive
Care Unit of Menoufia University.
To achieve this target, This study was carried on 75 patients of
proven /suspected sepsis who met the inclusion criteria (patients
group), 40 were males and 35 were females, their age ranged from
1months to 18 years and 25 apparently healthy children with age and
sex matched to the first group, considered as a (control group), their
age ranged from 1months to 18 years. This study done at Pediatric
Intensive Care Unit of Menoufia University, in the period from May
2021 to April 2022..
All children in the present study were subjected to detailed
history, Clinical examination, and laboratory Investigations had been
done. SOFA score was calculated within 24hrs of admission for each
patient, PRISM III score was calculated within 24hrs of admission for
each patient, using the 17th measured clinical and laboratory variables
and PIM2 score to detect mortality rate of each patient using clinical
data automatically on website http://www.sfar.org/scores2/pim22.php,
which calculated the PIM 2 score automatically.
Patients were classified into 4 subgroups: (1) SIRS patients
(n=14) (2) Sepsis patients (n=26) (3) Severe Sepsis patients (n=18) (4)
septic shock (n=17). Then follow up patients up to discharge from
PICU to calculate length of stay or death to calculate mortality rate.
We found that serum Copeptin was highly significantly
increased in patients group and patient subgroups (SIRS, sepsis,
severe sepsis and septic shock) than control. Also serum Copeptin was
significantly increased in sepsis group than SIRS group, highly
Summary
117
significantly increased in septic shock &severe sepsis group than
sepsis and SIRS group with good diagnostic value (p value < 0.001)..
Copeptin level was highly significantly increased in ventilated
patients than non-ventilated one, and in non survivors compared to
survivors (P value < 0.001).
There were significant positive correlations between copeptin
level and ICU stay, PRISM score, SOFA score,PRISM risk mortality
and WBCs (P value <0.05).The cutoff point of copeptin level of 2.34,
AUC was 0.995 had a sensitivity of 96% and specificity of 92% for
prediction of sepsis.
There were significant positive correlations between copeptin
level and ICU stay, PRISM score, PRISM risk mortality, SOFA and
WBCs.
There was significant increase in non survivors than survivors
regarding to ventilation, PRISM score, PRISM mortality risk%, PIM
II mortality risk% and SOFA (P value <0.05).
As regard Sensitivity and specificity of Copeptin, cutoff point
of copeptin of 6.80 had a sensitivity of 80% and specificity of 51.0%
for prediction of mortality and AUC 0.739(95% Confidence Intervals
CI: 0.621 – 0.857) (p <0.001).