Evaluation of outcome probability of perinatal brain damage using immunological parameters of blood

Abstract

Background. The risk of developing severe pathological conditions in young children with the consequences of perinatal brain damage (PBD) determines the need to create a prognostic model to assess the probability of a favorable/unfavorable outcome. Taking into account the involvement of immune mechanisms in the pathogenesis of PBD, the solution of this problem is possible based on the use of immunological blood indicators associated with the peculiarities of the clinical state of the patients.
Aim. To compare the level of immunological markers identified in the first year of life in PBD children with the dynamics of their clinical condition a year later, and to create a mathematical model for the prediction of the outcome of these pathological conditions.
Material and methods. 114 children with consequences of perinatal hypoxic-ischemic brain damage were examined in dynamics by the clinical observation. The first examination was carried out in children aged 6 to 12 mos (mean age 8.6 ± 2.7 mos), and the second examination after 9 - 12 mos (18.5 ± 3.5 mos). The control group consisted of 73 age-matched healthy children without signs of PBD. Immunological blood parameters, the activities of leukocyte elastase (LE) and a1-proteinase inhibitor (a1-PI), as well as the levels of antibodies to nervous tissue proteins (S100B, GFAP, MBP, NGF) were determined during the first examination.
Results. The activation of inflammatory, and in 25% of cases, of autoimmune reactions was evident in blood of children with PBD in the first year of life as compared with control children (p<0.05). The degree of immune system activation during the first clinical examination was associated with different dynamics of their mental development during the next year. Based on these findings, a binary logistic regression model was constructed. This model makes it possible to assess the PBD outcome based on the child’s immunological blood parameters and age. The diagnostic efficiency of the regression model was 79.8%, which demonstrates its high predictive value.

Conclusion. The results confirm the importance of immunological markers of LE activity and the level of antibodies to nervous tissue proteins as predictors of PBD consequences in children during the first year of life. The results allow us to recommend these indicators for objectifying the condition of patients at the early preclinical stages of PBD development.