Role of growth arrest-specific protein 6 in diagnosis and prognosis of sepsis in infants and children

Abstract

Background Sepsis is a main cause of mortality in the pediatrics and neonates. Early goal-directed therapy is the cornerstone in sepsis management that is focuses on keeping organ perfusion and function normally. Diagnosis of pediatric sepsis in the emergency department is considered a significant challenge for clinicians for many reasons. These include a lack of fast and accurate diagnostic tools, an absence of simple and specific diagnostic criteria, and unclear symptoms during the early phase of illness. The best predictive tool in the future will likely be a combination of multiple biomarkers and physiomarkers. Growth arrest-specific protein 6 (Gas6) is an anti-apoptotic vitamin-K-dependent protein. It is secreted by endothelial cells and is important for the activation of endothelium during inflammation. Several studies hypothesize the use of Gas6 as a biomarker in the pathophysiology of sepsis, an early predictor of mortality, and were able to identify some life-threatening sepsis complications. Aim Evaluation of the diagnostic and prognostic values of plasma Gas6 in patients with sepsis, septic shock, and multiple organ dysfunction syndrome in infants and children. Patients and methods Case-control study was carried out from April 2019 to April 2020. 90 children were included and divided into two equal groups (cases and controls). The patients aged from 1 month to 18 years were diagnosed with sepsis, septic shock, or multiple organ dysfunction syndrome in the pediatric intensive care unit of Mansoura University Children’s Hospital. The level of plasma Gas6 was measured in both cases and controls and evaluated as regards its relation to diagnosis and outcome of the cases. Results The two groups were age and sex matched. The outcome of the cases group was: 16 cases are discharged, and 29 died. A significant elevation of plasma Gas6 level in the cases more than the controls (sensitivity= 84.4% and specificity= 66.7%). However, no statistically significant difference as regard the relation between plasma Gas6 level and the outcome of the cases (sensitivity= 55.2% and specificity= 62.7%). Conclusion Gas6 show statistically significant elevation in cases of sepsis, septic shock and multiorgan failure. Gas6 plasma level has high accuracy in prediction of sepsis and can be considered as a good negative marker of sepsis but not a reliable prognostic marker in septic patients.