Niveles de neopterina y síndrome de respuesta inflamatoria sistémica en pacientes críticos pediátricos.

Abstract

Introducción: Laneopterina y biopterina, subproductos de reacciones redox, son cofactores en la producción de óxido nítrico. Hipótesis: Laneopterina y biopterina plasmáticas sufren evolución diferente durante los primeros días de una enfermedad crítica en pediatría. Métodos: Estudio prospectivo observacional monocéntrico en pacientes de 7 días a 14 años ingresados en UCIP con criterios de SRIS. Se recogieron, al ingreso y a las 24 h, los niveles de laneopterina y biopterina, otros reactantes de fase aguda y datos clínicos. Resultados: Se analizó a 28 pacientes, el 78,9% varones, de 5,04 años (RIQ 1,47-10,26), con PRISM II 2,0% (RIQ 1,1-5,0), ventilación mecánica (VM) en 90% (36,8% >24h), duración de VM de 6,0h (RIQ 3,7-102,0), ingreso en UCIP de 5,0 días (RIQ 2,7-18,7), media de VIS máximo de 0 (RIQ 0-14). La laneopterina inicial fue de 2,3±1,2 nmol/l y a las 24 h de 2,3±1,4 nmol/l. La biopterina basal fue 1,3±0,5 nmol/l y a las 24 h 1,4±0,4 nmol/l. La laneopterina fue significativamente mayor en estancia >6 días (p=0,02), VM >24h (p=0,023) y con complicaciones (p=0,05). La laneopterina se correlaciona de forma directa con la duración de VM (rho=0,6; p=0,011), la estancia en UCIP (rho=0,75; p<0,0001) y el VIS (rho=0,73; p=0,001). Adicionalmente, la biopterina se correlaciona directamente con el PRISM (rho=0,61; p=0,008) y la cifra de leucocitos (rho=0,88; p=0,002).

Neopterin and biopterin are sub-products of redox reactions, which act as cofactors of enzymes responsible for nitric oxide production. The hypothesis is presented that plasma neopterin and biopterin evolve differently during the first days in a critically ill child. A single-centre prospective observational study was conducted on patients 7 days to 14 years admitted to our Paediatric Intensive Care Unit (PICU) and that met Systemic inflammatory response syndrome (SIRS) criteria. Neopterin and biopterin levels, as well as other acute phase reactants, were collected at admission and at 24 h. A total of 28 patients were included, of which 78.9% were male, The median age was 5.04 years (interquartile range [IQR] 1.47-10.26), and PRISM II 2.0% (IQR 1.1-5.0). Mechanical ventilation (MV) was used in 90% of patients, with a median duration of 6.0 hrs (IQR 3.7-102.0). The median length of stay in PICU was 5.0 days (IQR 2.7-18.7), maximum VIS mean of 0 (IQR 0-14). Baseline neopterin level was 2.3±1.2 nmol/l and at 24 h it was 2.3±1.4 nmol/l. Baseline biopterin was 1.3±0.5 nmol/l and 1.4±0.4 nmol/l at 24 h. Neopterin levels were significantly higher in patients with PICU length of stay > 6 days (P=.02), patients who needed MV >24 h (P=.023), and those who developed complications (P=.05). Neopterin correlates directly and is statistically significant with the duration of MV (rho=.6, P=.011), PICU length of stay (rho=.75, P 6 days (P=.02), patients who needed MV >24 h (P=.023), and those who developed complications (P=.05). Neopterin correlates directly and is statistically significant with the duration of MV (rho=.6, P=.011), PICU length of stay (rho=.75, P24 h (P=.023), and those who developed complications (P=.05). Neopterin correlates directly and is statistically significant with the duration of MV (rho=.6, P=.011), PICU length of stay (rho=.75, P There is a higher neopterin level when there is a longer PICU stay, higher VIS score, longer time on MV, and occurrence of complications, indicating the involvement of an activation of the cellular immune system.