Serum Relmβ combined with abdominal signs may predict surgical timing in neonates with NEC: A cohort study

Abstract

AimsTo examine the predictive value of serum biomarkers combined with other indicators for necrotizing enterocolitis (NEC) surgery decision-making.MethodsClinical data, including baseline information, clinical features, imaging presentation and serum assessment, of the infants enrolled were collected, and the serum concentrations of HBD2, HMGB-1, Claudin-3 and Relmβ were determined. Student's t test, the Mann–Whitney U test, the chi-square test and logistic regression analysis were used. Receiver operating characteristic (ROC) curves were also generated.ResultsForty-nine infants were enrolled, with 23 in the surgical NEC group and 26 in the medical NEC group. There were no differences in the baseline clinical information, including birth weight, gestational age, admission age and risk factors, during pregnancy and before enrollment (P > 0.05). Peritonitis, intestinal adhesion and sepsis were more common in the surgical group (P < 0.05). The incidences of abdominal distention, abdominal wall tenseness, abdominal tenderness and absent bowel sounds in the surgical group were significantly higher when NEC occurred (P < 0.05). There were no differences between the two groups in the imaging presentation (P > 0.05). The concentration of Relmβ {[8.66 (4.29, 19.28) vs. 20.65 (9.51, 44.65)]} in the surgical group was significantly higher (P < 0.05). Abdominal wall tenseness, abdominal tenderness and a Relmβ concentration > 19.7 μmol/L were included in the predictive model, and the AUC of the predictive score was 0.943 (95% CI: 0.891–1.000) (P < 0.05).ConclusionSerum Relmβ concentration combined with abdominal wall tenseness and abdominal tenderness may be useful in determining surgical timing in neonates with NEC.

Fecal HBD-2 and Claudin-3 may be potential biomarkers to predict the deterioration of necrotizing enterocolitis: A prospective study

“…In addition, we measured the fecal concentration of HMGB-1 and Relmβ in our study. Fecal HMGB-1 has been reported to be helpful in the diagnosis of NEC ( 15 ), and our previous study found that in those needing surgeries, the level of serum Relmβ was even higher ( 12 ). HMGB-1 participates in intestinal inflammation of NEC by inhibiting the NLR pyrin domain containing 3 via Toll-like receptor 4 and nuclear factor-kappaB signaling pathways and decreases intestinal microcirculatory perfusion by rescuing nitric oxide production and eliminating oxygen production through endothelial nitric oxide synthase activation ( 23 , 37 ).…”

“…Human β-defensin 2 (HBD-2), Claudin-3, high-mobility group box-1 protein (HMGB-1), and resistin-like molecule β (Relmβ) are potential biomarkers in intestinal inflammation, and they have been proposed as such in the diagnosis of NEC (10)(11)(12)(13)(14)(15). HBD-2 is an antibacterial peptide in the innate immune system of the intestinal mucosa that can regulate the immune response with Toll-like receptor 4 and other recognition receptors to maintain the normal function that is expressed in inflammation but not in normal epithelial tissues (16)(17)(18).…”

Chromatin as alarmins in necrotizing enterocolitis

“…Patients with NEC have been shown to have higher expression of HMGB1 than healthy control counterparts (19,27). Levels of HMGB1 were not substantially different in patients with Stage II or Stage III NEC (when measured in the stool), or patients who were managed medically or surgically (when measured in the serum) (91,92). Nevertheless, HMGB1 levels in stool samples were higher in preterm neonates compared to full-term neonates with birth weight less than 2.5 kg, and early HMGB1 fecal levels were predictive of NEC risk, thus implicating stool HMGB1 as a potential clinical biomarker in this disease (29).…”

Neonatal complicated intraabdominal infection

“…As such, a specific biomarker or panel of biomarkers to specifically identify NEC would be ideal. Investigations continue for biomarkers of NEC, but widespread clinical application of these markers is limited (Table 1) [15 ▪ ,16–20]. Faecal HBD-2 and Claudin-3 may be potential biomarkers to predict the deterioration of NEC from Stage II to Stage III but will need further validation [16].…”