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Trefoil factor 2 expression and its significance as a predictor of severity of sepsis in children
Jiří Zurek1, Michal Kýr, Martin Vavřina
1Department of Anesthesia and Intensive Care, University Children's Hospital, Černopolní 9, Brno 62500, Czech Republic. jzurek@fnbrno.cz
Insights
Trefoil Factor 2 (TFF2) levels were stable in critically ill children over five days. Higher TFF2 levels indicate Multiple Organ Dysfunction Syndrome (MODS) in sepsis patients.
Area of Science:
- Gastroenterology
- Critical Care Medicine
- Biomarker Discovery
Background:
- Intestinal injury is a key factor in critical illness, sepsis, and multiorgan failure.
- Trefoil Factor 2 (TFF2) is a gastric-secreted protein whose gene expression increases post-gut injury.
- TFF2 expression expands to the gastrointestinal tract's regenerative epithelia following injury.
Purpose of the Study:
- To analyze the dynamics of TFF2 levels in pediatric patients with Systemic Inflammatory Response Syndrome (SIRS) or sepsis over five days.
- To establish an optimal cut-off value for TFF2 to differentiate septic states from controls.
- To quantify the diagnostic characteristics of TFF2 in pediatric sepsis and SIRS.
Main Methods:
- Study included 57 children (0-19 years) with SIRS or sepsis, assessed using the Pediatric Logistic Organ Dysfunction (PELOD) Score.
- Blood samples were collected to measure TFF2 levels during SIRS or sepsis criteria.
- Control samples were obtained from children undergoing elective surgery.
Main Results:
- TFF2 levels remained stable over the 5-day observation period.
- Significantly elevated TFF2 levels were observed in patients with Multiple Organ Dysfunction Syndrome (MODS).
- Receiver Operating Characteristic (ROC) analysis confirmed significant differences in TFF2 levels between patient groups.
Conclusions:
- TFF2 levels do not fluctuate significantly in pediatric SIRS/sepsis over five days.
- Elevated serum TFF2 is a potential indicator of MODS in pediatric sepsis.
- TFF2 demonstrates diagnostic potential for differentiating septic conditions in children.
Abstract:
Intestinal injury significantly contributes to critical illness, sepsis and multiorgan failure. TFF2 (Trefoil Factor 2) is expressed and secreted preferentially by gastric mucous neck cells. TFF2 gene expression is promptly increased after gut injury, and its expression profile broadens to include the regenerative epithelia of virtually the entire gastrointestinal tract. The first objective of our study was an analysis of TFF2 levels dynamics in patients with Systemic Inflammatory Response Syndrome (SIRS) or septic condition during a 5-day period after admission. The second objective was to determine optimal cut-off value and quantify diagnostic characteristics of TFF2 between controls and patients with various septic states. The study included 57 children aged 0-19 years, with expected or proven SIRS and septic condition. The degree of severity was evaluated according to PELOD Score (Pediatric Logistic Organ Dysfunction). Blood samples to determine levels of TFF2 factor were taken during the time patient met the criteria of SIRS or sepsis. Control group samples to determine the serum levels of TFF2 were taken from patients undergoing elective surgery. Analysis of TFF2 levels dynamics revealed that TFF2 levels kept steady state during the 5-day period. Significantly higher levels of TFF2 were in patients with Multiple Organ Dysfunction Syndrome (MODS). The difference was noticed also in ROC analysis.
