Pre-Conditioning Serum Uric Acid as a Risk Factor for Sinusoidal
Obstruction Syndrome of the Liver in Children Undergoing
Hematopoietic Stem Cell Transplantation

Kuskonmaz, Baris; ARSLAN, Umut Ece; WARASNHE, Khaled Warasnhe Khaled; Karapapak, Murat; OKUR, FATMA VISAL; ÇETİNKAYA, Duygu

doi:10.4274/tjh.galenos.2021.2021.0174

Pre-Conditioning Serum Uric Acid as a Risk Factor for Sinusoidal Obstruction Syndrome of the Liver in Children Undergoing Hematopoietic Stem Cell Transplantation

Fatma Visal Okur, (1Hacettepe University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Hematology and Pediatric BMT Unit, Ankara, Turkey)

Murat Karapapak, (1Hacettepe University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Hematology and Pediatric BMT Unit, Ankara, Turkey)

Khaled Warasnhe Khaled WARASNHE, (1Hacettepe University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Hematology and Pediatric BMT Unit, Ankara, Turkey)

Umut Ece Arslan, (2Hacettepe University, Institute of Public Health, Department of Health Research, Ankara, Turkey)

Barış Kuşkonmaz, (2Hacettepe University, Institute of Public Health, Department of Health Research, Ankara, Turkey)

Duygu Çetinkaya (1Hacettepe University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Hematology and Pediatric BMT Unit, Ankara, Turkey)

Turkish Journal of Hematology

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Yıl: 2021 Cilt: 38 Sayı: 4 Sayfa Aralığı: 286 - 293 Metin Dili: İngilizce DOI: 10.4274/tjh.galenos.2021.2021.0174 İndeks Tarihi: 25-05-2022

Pre-Conditioning Serum Uric Acid as a Risk Factor for Sinusoidal Obstruction Syndrome of the Liver in Children Undergoing Hematopoietic Stem Cell Transplantation

Öz:

Objective: Uric acid (UA), a known danger signal released from injured cells, is a valuable sign of inflammation. We aimed to evaluate the association of serum UA levels before the start of conditioning regimens with the risk of hepatic sinusoidal obstruction syndrome (SOS) development after hematopoietic stem cell transplantation (HSCT). Materials and Methods: Two hundred and twenty-two children who underwent allogeneic HSCT at the Pediatric BMT Unit of Hacettepe University between 2000 and 2014 were included in this retrospective study. Serum UA levels were measured before conditioning as an indicator of the pre-transplant inflammatory status of the patients. Patients with and without a diagnosis of SOS were compared regarding primary diagnosis, previously described risk factors for SOS, and preconditioning serum UA. Results: SOS was diagnosed in 42 patients who had higher pre-conditioning serum UA levels compared to those who did not. Pre-transplant serum creatinine, gamma-glutamyl transferase, bilirubin, ferritin, and C-reactive protein levels did not differ significantly among patients with and without SOS; however, serum albumin was lower in the patients who developed SOS. Receiver operating characteristic analysis revealed that a pre-conditioning UA level higher than 3.32 mg/dL was predictive of SOS. When applied to a multivariate model, only pre-conditioning UA and albumin levels remained significant risk factors for SOS (UA: odds ratio [OR], 2.54; 95% confidence interval [CI], 1.26-5.12, p=0.009; albumin: OR, 0.45, 95% CI, 0.22-0.95, p=0.037). Conclusion: Our results suggest that pre-conditioning serum UA is an independent risk factor for SOS, and it might be used as an early predictor of hepatic SOS together with previously described clinical and laboratory parameters.

Anahtar Kelime:

Hematopoetik Kök Hücre Transplantasyonu Yapılan Çocuklarda Karaciğer Sinüzoidal Obstrüksiyon Sendromu için Bir Risk Faktörü Olarak Rejim Öncesi Serum Ürik Asit Düzeyi

Öz:

Amaç: Hasarlı hücrelerden salınan bilinen bir tehlike sinyali olan ürik asit (ÜA), önemli bir enflamasyon belirtecidir. Bu çalışmayı hazırlama rejimine başlamadan önce bakılan serum ürik asit seviyesi ile hematopoetik kök hücre transplantasyonu (HKHT) sonrası hepatik sinüzoidal obstrüksiyon sendromu (SOS) gelişimi riski arasındaki ilişkiyi değerlendirmeyi amaçladık. Gereç ve Yöntemler: Bu retrospektif çalışmaya Hacettepe Üniversitesi Pediatrik KİT Ünitesi’nde 2000-2014 yılları arasında allojenik HKHT uygulanan 222 çocuk hasta dahil edildi. Serum ÜA seviyeleri, hastaların transplantasyon öncesi enflamatuvar durumunun bir göstergesi olarak hazırlama rejimi öncesi ölçülmüştür. SOS tanısı olan ve olmayan hastalar, birincil tanı, SOS için daha önce tanımlanan risk faktörleri ve rejim öncesi serum ÜA açısından karşılaştırıldı. Bulgular: SOS tanısı alan 42 hastada rejim öncesi ÜA düzeyleri olmayan hastalara göre daha yüksek saptandı. Nakil öncesi bakılan serum kreatinin, gama-glutamil transferaz, bilirubin, ferritin ve C-reaktif protein parametreler açısından daha düşük olan serum albümini dışında, SOS gelişen hastalar ile gelişmeyen hastalar arasında anlamlı farklılık gözlenmedi. ROC analizi, 3,32 mg/dL’den yüksek rejim öncesi ÜA düzeyinin SOS gelişimini öngördüğünü ortaya koydu. Çok değişkenli bir modele uygulandığında, yalnızca rejim öncesi ÜA ve albümin seviyeleri SOS için önemli risk faktörleri belirlendi (ÜA; odds ratio (OR), 2,54; %95 güven aralığı (GA), 1,26 ila 5,12; p=0,009 ve albumin; OR, 0,45; %95 GA, 0,22 ila 0,95; p=0,037). Sonuç: Sonuçlarımız, rejim öncesi serum ÜA düzeyinin SOS için bağımsız bir risk faktörü olduğunu ve önceden tanımlanmış klinik/ laboratuvar parametreleriyle birlikte hepatik SOS’nin gelişimi açısından erken bir belirteç olarak kullanılabileceğini göstermektedir.

Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

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APA	OKUR F, Karapapak M, WARASNHE K, ARSLAN U, Kuskonmaz B, ÇETİNKAYA D (2021). Pre-Conditioning Serum Uric Acid as a Risk Factor for Sinusoidal Obstruction Syndrome of the Liver in Children Undergoing Hematopoietic Stem Cell Transplantation. , 286 - 293. 10.4274/tjh.galenos.2021.2021.0174
Chicago	OKUR FATMA VISAL,Karapapak Murat,WARASNHE Khaled Warasnhe Khaled,ARSLAN Umut Ece,Kuskonmaz Baris,ÇETİNKAYA Duygu Pre-Conditioning Serum Uric Acid as a Risk Factor for Sinusoidal Obstruction Syndrome of the Liver in Children Undergoing Hematopoietic Stem Cell Transplantation. (2021): 286 - 293. 10.4274/tjh.galenos.2021.2021.0174
MLA	OKUR FATMA VISAL,Karapapak Murat,WARASNHE Khaled Warasnhe Khaled,ARSLAN Umut Ece,Kuskonmaz Baris,ÇETİNKAYA Duygu Pre-Conditioning Serum Uric Acid as a Risk Factor for Sinusoidal Obstruction Syndrome of the Liver in Children Undergoing Hematopoietic Stem Cell Transplantation. , 2021, ss.286 - 293. 10.4274/tjh.galenos.2021.2021.0174
AMA	OKUR F,Karapapak M,WARASNHE K,ARSLAN U,Kuskonmaz B,ÇETİNKAYA D Pre-Conditioning Serum Uric Acid as a Risk Factor for Sinusoidal Obstruction Syndrome of the Liver in Children Undergoing Hematopoietic Stem Cell Transplantation. . 2021; 286 - 293. 10.4274/tjh.galenos.2021.2021.0174
Vancouver	OKUR F,Karapapak M,WARASNHE K,ARSLAN U,Kuskonmaz B,ÇETİNKAYA D Pre-Conditioning Serum Uric Acid as a Risk Factor for Sinusoidal Obstruction Syndrome of the Liver in Children Undergoing Hematopoietic Stem Cell Transplantation. . 2021; 286 - 293. 10.4274/tjh.galenos.2021.2021.0174
IEEE	OKUR F,Karapapak M,WARASNHE K,ARSLAN U,Kuskonmaz B,ÇETİNKAYA D "Pre-Conditioning Serum Uric Acid as a Risk Factor for Sinusoidal Obstruction Syndrome of the Liver in Children Undergoing Hematopoietic Stem Cell Transplantation." , ss.286 - 293, 2021. 10.4274/tjh.galenos.2021.2021.0174
ISNAD	OKUR, FATMA VISAL vd. "Pre-Conditioning Serum Uric Acid as a Risk Factor for Sinusoidal Obstruction Syndrome of the Liver in Children Undergoing Hematopoietic Stem Cell Transplantation". (2021), 286-293. https://doi.org/10.4274/tjh.galenos.2021.2021.0174

APA	OKUR F, Karapapak M, WARASNHE K, ARSLAN U, Kuskonmaz B, ÇETİNKAYA D (2021). Pre-Conditioning Serum Uric Acid as a Risk Factor for Sinusoidal Obstruction Syndrome of the Liver in Children Undergoing Hematopoietic Stem Cell Transplantation. Turkish Journal of Hematology, 38(4), 286 - 293. 10.4274/tjh.galenos.2021.2021.0174
Chicago	OKUR FATMA VISAL,Karapapak Murat,WARASNHE Khaled Warasnhe Khaled,ARSLAN Umut Ece,Kuskonmaz Baris,ÇETİNKAYA Duygu Pre-Conditioning Serum Uric Acid as a Risk Factor for Sinusoidal Obstruction Syndrome of the Liver in Children Undergoing Hematopoietic Stem Cell Transplantation. Turkish Journal of Hematology 38, no.4 (2021): 286 - 293. 10.4274/tjh.galenos.2021.2021.0174
MLA	OKUR FATMA VISAL,Karapapak Murat,WARASNHE Khaled Warasnhe Khaled,ARSLAN Umut Ece,Kuskonmaz Baris,ÇETİNKAYA Duygu Pre-Conditioning Serum Uric Acid as a Risk Factor for Sinusoidal Obstruction Syndrome of the Liver in Children Undergoing Hematopoietic Stem Cell Transplantation. Turkish Journal of Hematology, vol.38, no.4, 2021, ss.286 - 293. 10.4274/tjh.galenos.2021.2021.0174
AMA	OKUR F,Karapapak M,WARASNHE K,ARSLAN U,Kuskonmaz B,ÇETİNKAYA D Pre-Conditioning Serum Uric Acid as a Risk Factor for Sinusoidal Obstruction Syndrome of the Liver in Children Undergoing Hematopoietic Stem Cell Transplantation. Turkish Journal of Hematology. 2021; 38(4): 286 - 293. 10.4274/tjh.galenos.2021.2021.0174
Vancouver	OKUR F,Karapapak M,WARASNHE K,ARSLAN U,Kuskonmaz B,ÇETİNKAYA D Pre-Conditioning Serum Uric Acid as a Risk Factor for Sinusoidal Obstruction Syndrome of the Liver in Children Undergoing Hematopoietic Stem Cell Transplantation. Turkish Journal of Hematology. 2021; 38(4): 286 - 293. 10.4274/tjh.galenos.2021.2021.0174
IEEE	OKUR F,Karapapak M,WARASNHE K,ARSLAN U,Kuskonmaz B,ÇETİNKAYA D "Pre-Conditioning Serum Uric Acid as a Risk Factor for Sinusoidal Obstruction Syndrome of the Liver in Children Undergoing Hematopoietic Stem Cell Transplantation." Turkish Journal of Hematology, 38, ss.286 - 293, 2021. 10.4274/tjh.galenos.2021.2021.0174
ISNAD	OKUR, FATMA VISAL vd. "Pre-Conditioning Serum Uric Acid as a Risk Factor for Sinusoidal Obstruction Syndrome of the Liver in Children Undergoing Hematopoietic Stem Cell Transplantation". Turkish Journal of Hematology 38/4 (2021), 286-293. https://doi.org/10.4274/tjh.galenos.2021.2021.0174