Blood serum transthyretin and the dynamics of transthyretin/C-reactive protein ratio in children with acute hypoxemic respiratory failure: prevalence of disorders and impact on outcomes
Background. Protein-deficient malnutrition is one of the common disorders of nutritional status that affects the clinical condition, course and prognosis of diseases in children. The purpose of this study was to investigate the prevalence of transthyretin levels decreasing, the dynamics of the transthyretin/C-reactive protein ratio, duration of staying at the pediatric intensive care unit, and 28-day mortality rate in children with acute hypoxemic respiratory failure. Materials and methods. We complete the prospective single-centre cohort study (May 2018 — May 2019) at the Department of Anesthesiology and Intensive Care, Danylo Halytsky Lviv National Medical University; Department of Anesthesiology and Intensive Care, Lviv Regional Children Hospital OCHMATDYT. We included the patients aged from 3 to 12 years old with acute respiratory failure on invasive mechanical ventilation. Serum transthyretin (TTR) level was evaluated on the day 1 (d1), day 3 (d3), 5 (d5), 7 (d7) and 9 (d9). We included 19 patients in study results analysis. Patients were divided into the following subgroups: 1st subgroup — children with transthyretin levels over 150 mg/l (no malnutrition); 2nd subgroup — serum TTR level 120–150 mg/l (mild malnutrition); 3rd subgroup — TTR level 80–100 mg/l (moderate malnutrition); 4th subgroup — TTR level under 80 mg/l (severe malnutrition). Results. The transthyretin level below 150 mg/l was determined in 10 out of 19 patients included in the study results analysis (52.6 %) on d1; in 7 patients out of 15 (46.7 %) on d3; in 6 patients out of 10 (60 %) on d5, in 3 patients out of 4 (75 %) and in one patient out of 4 (25 %) on d7 and d9, respectively. Our investigation reveals the increased ratio of transthyretin to C-reactive protein in the 1st subgroup of patients from 2.83 on d1 to 13 and 31 on d5 and d9, respectively (p = 0.12 and p = 0.06 in comparison with d1). In patients of the 4th subgroup this ratio was 0.53 at d1; and 0.25 at d5 and 0.33 at d9 (p = 0.72 and p = 0.56 in comparison with d1). The 28-day mortality rate in patients of the 1st subgroup was 11.1 %, in the 4th subgroup — 42.9 % (p = 0.18 compared to the 1st subgroup of patients). All patients of the 2nd and 3rd subgroups survived. The duration of staying at pediatric intensive care unit for the 1st subgroup of patients was 14.8 days [12.5; 19.7]; for the 4th subgroup of patients — 23.2 days [19.1; 29.5] (p = 0.11). Conclusions. Our study reveals the presence of acute nutritive disorders in 52.6 % of patients with hypoxemic respiratory failure at admission. The transthyretin/C-reactive protein ratio diminished during the study period in patients with severe malnutrition. The 28-day mortality rate in patients without acute nutritional disorders was 11.1 %, in patients with acute severe malnutrition — 42.9 % (p = 0.18).
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