title: Prognostic utility of serum neopterin in obstructive jaundice secondary to malignant lesions treated by percutaneous transhepatic biliary drainage.
abstract: OBJECTIVE
  To perform biochemical profiles before and after percutaneous transhepatic biliary drainage (PTBD) and investigate the potential utility of measuring C-reactive protein (CRP), circulating cytokines, and neopterin, a marker of cell-mediated immunity, to predict outcomes of patients with obstructive jaundice.
  
  
  METHODS
  In a prospective study, 47 patients with obstructive jaundice secondary to malignant lesions were evaluated before, at the fifth hour after, and on the fifth day after PTBD for neopterin, nitrate, tumor necrosis factor (TNF)-α, interleukin (IL)-6, IL-10, CRP levels, and liver function.
  
  
  RESULTS
  Neopterin levels on day 5 after PTBD were significantly higher than the levels before treatment and at the fifth hour. However, nitrate, cytokine, white blood cell, albumin, and creatinine levels were not significantly different. On the fifth day after PTBD, CRP levels were significantly higher and total bilirubin, direct bilirubin, alkaline phosphatase, aspartate transaminase, and alanine transaminase values were lower than the before-treatment values. Seven patients (15%) died within 30 days after drainage. On the fifth day after PTBD, neopterin, IL-6, IL-10, and creatinine levels were significantly higher and albumin levels were lower in the early mortality group. The performance characteristics of neopterin and creatinine were statistically significant in predicting mortality.
  
  
  CONCLUSIONS
  Neopterin levels increased after PTBD, indicating cellular immune activation. The nonsignificant change in cytokine levels may be related to low enduring release in malignancy. The extremely elevated levels of neopterin and creatinine after PTBD might serve as harbingers of early death in patients with cholestasis secondary to malignant lesions.
authors.affiliation: Department of Biochemistry, Ege University Faculty of Medicine, Bornova, Izmir 35100, Turkey.
authors.forename: Betul
authors.initials: B
authors.lastname: Yilmaz
authors.forename: Zuhal
authors.initials: Z
authors.lastname: Parildar
authors.forename: Halil
authors.initials: H
authors.lastname: Bozkaya
authors.forename: Burcu
authors.initials: B
authors.lastname: Barutcuoglu
authors.forename: Celal
authors.initials: C
authors.lastname: Cinar
authors.forename: Gunes
authors.initials: G
authors.lastname: Basol
authors.forename: Mustafa
authors.initials: M
authors.lastname: Parildar
authors.forename: Dilek
authors.initials: D
authors.lastname: Ozmen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002758:Cholangiography / Q000379:methods; D016207:Cytokines / Q000097:blood; D004322:Drainage / Q000379:methods*; D006801:Humans; D041781:Jaundice, Obstructive / Q000097:blood* / Q000209:etiology / Q000601:surgery*; D008113:Liver Neoplasms / Q000097:blood* / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019798:Neopterin / Q000097:blood*; D011379:Prognosis; D015641:Radiography, Interventional / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D016207:Cytokines; D019798:Neopterin