Diagnostic and prognostic value of Nesfatin-1 in sepsis and septic shock

İlkim Toprak; Hasan Eruzun; Yasin Kutlu; Yücel Arman; Pembegül Yumuştutan; Şengül Aydın Yoldemir; Murat Akarsu; Okan Dikker; Tufan Tükek

Research Article

Year 2022, Volume: 39 Issue: 1, 1 - 6, 01.01.2022

İlkim Toprak Hasan Eruzun Yasin Kutlu Yücel Arman Pembegül Yumuştutan Şengül Aydın Yoldemir Murat Akarsu Okan Dikker Tufan Tükek

Abstract

References

1. Oh-I S, Shimizu H, Satoh T, Okada S, Adachi S, Inoue K, et al. Identification of nesfatin-1 as a satiety molecule in the hypothalamus. Nature. 2006 Oct 12;443(7112):709-12. doi: 10.1038/nature05162. Epub 2006 Oct 1. PMID: 17036007.
2. Aydin S. Role of NUCB2/nesfatin-1 as a possible biomarker. Curr Pharm Des. 2013;19(39):6986-92. doi: 10.2174/138161281939131127143422. PMID: 23537082.
3. Stengel A, Hofmann T, Goebel-Stengel M, Lembke V, Ahnis A, Elbelt U, et al. Ghrelin and NUCB2/nesfatin-1 are expressed in the same gastric cell and differentially correlated with body mass index in obese subjects. Histochem Cell Biol. 2013 Jun;139(6):909-18. doi: 10.1007/s00418-013-1087-8. Epub 2013 Mar 21. PMID: 23515787.
4. Heidarzadeh H, Zendehdel M, Babapour V, Gilanpour H. The effect of Nesfatin-1 on food intake in neonatal chicks: role of CRF1 /CRF2 and H1/ H3 receptors. Vet Res Commun. 2018 Mar;42(1):39-47. doi: 10.1007/s11259-017-9706-9. Epub 2017 Dec 26. PMID: 29280084.
5. Maejima Y, Horita S, Kobayashi D, Aoki M, O'hashi R, Imai R, et al. Nesfatin-1 inhibits voltage gated K+ channels in pancreatic beta cells. Peptides. 2017 Sep; 95:10-15. doi: 10.1016/j.peptides.2017.07.001. Epub 2017 Jul 8. PMID: 28697955.
6. Zhang H, Qi C, Li L, Luo F, Xu Y. Clinical significance of NUCB2 mRNA expression in prostate cancer. J Exp Clin Cancer Res. 2013 Aug 16;32(1):56. doi: 10.1186/1756-9966-32-56. PMID: 23958433; PMCID: PMC3751731.
7. Ünal K, Yüksel RN, Turhan T, Sezer S, Yaylaci ET. The association of serum nesfatin-1 and ghrelin levels with metabolic syndrome in patients with schizophrenia. Psychiatry Res. 2018 Mar;261:45-49. doi: 10.1016/j.psychres.2017.12.041. Epub 2017 Dec 20. PMID: 29278806.
8. Akour A, Kasabri V, Boulatova N, Bustanji Y, Naffa R, Hyasat D, et al. Levels of metabolic markers in drug-naive prediabetic and type 2 diabetic patients. Acta Diabetol. 2017 Feb;54(2):163-170. doi: 10.1007/s00592-016-0926-1. Epub 2016 Oct 18. PMID: 27752839.
9. Algul S, Ozkan Y, Ozcelik O. Serum nesfatin-1 levels in patients with different glucose tolerance levels. Physiol Res. 2016 Dec 13;65(6):979-985. doi: 10.33549/physiolres.933186. Epub 2016 Aug 19. PMID: 27539099.
10. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016 Feb 23;315(8):801-10. doi: 10.1001/jama.2016.0287. PMID: 26903338; PMCID: PMC4968574.
11. Cetinkaya H, Karagöz B, Bilgi O, Ozgün A, Tunçel T, Emirzeoğlu L, et al. Nesfatin-1 in advanced lung cancer patients with weight loss. Regul Pept. 2013 Feb 10;181:1-3. doi: 10.1016/j.regpep.2012.11.005. Epub 2012 Dec 23. PMID: 23269222.
12. Jiang G, Wang M, Wang L, Chen H, Chen Z, Guo J, et al. The protective effect of nesfatin-1 against renal ischemia-reperfusion injury in rats. Ren Fail. 2015 Jun;37(5):882-9. doi: 10.3109/0886022X.2015.1015426. Epub 2015 Feb 24. PMID: 25707521.
13. Saldanha JF, Carrero JJ, Lobo JC, Stockler-Pinto MB, Leal VO, Calixto A, et al. The newly identified anorexigenic adipokine nesfatin-1 in hemodialysis patients: Are there associations with food intake, body composition and inflammation? Regul Pept. 2012 Jan 10;173(1-3):82-5. doi: 10.1016/j.regpep.2011.09.010. Epub 2011 Oct 26. PMID: 22036920.
14. Kaukonen KM, Bailey M, Suzuki S, Pilcher D, Bellomo R. Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000-2012. JAMA. 2014 Apr 2;311(13):1308-16. doi: 10.1001/jama.2014.2637. PMID: 24638143.
15. Dombrovskiy VY, Martin AA, Sunderram J, Paz HL. Facing the challenge: decreasing case fatality rates in severe sepsis despite increasing hospitalizations. Crit Care Med. 2005 Nov;33(11):2555-62. doi: 10.1097/01.ccm.0000186748.64438.7b. PMID: 16276180.
16. Winters BD, Eberlein M, Leung J, Needham DM, Pronovost PJ, Sevransky JE. Long-term mortality and quality of life in sepsis: a systematic review. Crit Care Med. 2010 May;38(5):1276-83. doi: 10.1097/CCM.0b013e3181d8cc1d. PMID: 20308885.
17. Epstein L, Dantes R, Magill S, Fiore A. Varying Estimates of Sepsis Mortality Using Death Certificates and Administrative Codes--United States, 1999-2014. MMWR Morb Mortal Wkly Rep. 2016 Apr 8;65(13):342-5. doi: 10.15585/mmwr.mm6513a2. PMID: 27054476.
18. Ou SM, Chu H, Chao PW, Lee YJ, Kuo SC, Chen TJ, et al. Long-Term Mortality and Major Adverse Cardiovascular Events in Sepsis Survivors. A Nationwide Population-based Study. Am J Respir Crit Care Med. 2016 Jul 15;194(2):209-17. doi: 10.1164/rccm.201510-2023OC. PMID: 26808711.
19. Prescott HC, Osterholzer JJ, Langa KM, Angus DC, Iwashyna TJ. Late mortality after sepsis: propensity matched cohort study. BMJ. 2016 May 17;353:i2375. doi: 10.1136/bmj.i2375. PMID: 27189000; PMCID: PMC4869794.
20. Jones TK, Fuchs BD, Small DS, Halpern SD, Hanish A, Umscheid CA, et al. Post-Acute Care Use and Hospital Readmission after Sepsis. Ann Am Thorac Soc. 2015 Jun;12(6):904-13. doi: 10.1513/AnnalsATS.201411-504OC. PMID: 25751120; PMCID: PMC4590016.
21. Prescott HC, Langa KM, Iwashyna TJ. Readmission diagnoses after hospitalization for severe sepsis and other acute medical conditions. JAMA. 2015 Mar 10;313(10):1055-7. doi: 10.1001/jama.2015.1410. PMID: 25756444; PMCID: PMC4760618.
22. Prescott HC, Langa KM, Liu V, Escobar GJ, Iwashyna TJ. Increased 1-year healthcare use in survivors of severe sepsis. Am J Respir Crit Care Med. 2014 Jul 1;190(1):62-9. doi: 10.1164/rccm.201403-0471OC. PMID: 24872085; PMCID: PMC4226030.
23. Knaus WA, Sun X, Nystrom O, Wagner DP. Evaluation of definitions for sepsis. Chest. 1992 Jun;101(6):1656-62. doi: 10.1378/chest.101.6.1656. PMID: 1600787.
24. Peres Bota D, Lopes Ferreira F, Mélot C, Vincent JL. Body temperature alterations in the critically ill. Intensive Care Med. 2004 May;30(5):811-6. doi: 10.1007/s00134-004-2166-z. Epub 2004 Feb 4. PMID: 15127194.
25. Kreger BE, Craven DE, McCabe WR. Gram-negative bacteremia. IV. Re-evaluation of clinical features and treatment in 612 patients. Am J Med. 1980 Mar;68(3):344-55. doi: 10.1016/0002-9343(80)90102-3. PMID: 6987871.
26. Haase N, Ostrowski SR, Wetterslev J, Lange T, Møller MH, Tousi H, et al. Thromboelastography in patients with severe sepsis: a prospective cohort study. Intensive Care Med. 2015 Jan;41(1):77-85. doi: 10.1007/s00134-014-3552-9. Epub 2014 Nov 21. PMID: 25413378.
27. Neyra JA, Canepa-Escaro F, Li X, Manllo J, Adams-Huet B, Yee J, et al; Acute Kidney Injury in Critical Illness Study Group. Association of Hyperchloremia With Hospital Mortality in Critically Ill Septic Patients. Crit Care Med. 2015 Sep;43(9):1938-44. doi: 10.1097/CCM.0000000000001161. PMID: 26154934; PMCID: PMC4537691.
28. Schuetz P, Birkhahn R, Sherwin R, Jones AE, Singer A, Kline JA, et al. Serial Procalcitonin Predicts Mortality in Severe Sepsis Patients: Results From the Multicenter Procalcitonin MOnitoring SEpsis (MOSES) Study. Crit Care Med. 2017 May;45(5):781-789. doi: 10.1097/CCM.0000000000002321. PMID: 28257335; PMCID: PMC5389588.
29. Freund Y, Lemachatti N, Krastinova E, Van Laer M, Claessens YE, Avondo A, et al; French Society of Emergency Medicine Collaborators Group. Prognostic Accuracy of Sepsis-3 Criteria for In-Hospital Mortality Among Patients With Suspected Infection Presenting to the Emergency Department. JAMA. 2017 Jan 17;317(3):301-308. doi: 10.1001/jama.2016.20329. PMID: 28114554.
30. Xu Y, Chen F. Antioxidant, Anti-Inflammatory and Anti-Apoptotic Activities of Nesfatin-1: A Review. J Inflamm Res. 2020 Sep 28;13:607-617. doi: 10.2147/JIR.S273446. PMID: 33061526; PMCID: PMC7532075.

Diagnostic and prognostic value of Nesfatin-1 in sepsis and septic shock

Year 2022, Volume: 39 Issue: 1, 1 - 6, 01.01.2022

İlkim Toprak Hasan Eruzun Yasin Kutlu Yücel Arman Pembegül Yumuştutan Şengül Aydın Yoldemir Murat Akarsu Okan Dikker Tufan Tükek

Abstract

Nesfatin-1 is an anorectic protein, and we expect it to decrease during sepsis and septic shock. We aimed to analyze it and determine the relationship between Nesfatin-1 levels and quick Sequential Organ Failure Assessment(qSOFA) score, renal Sequential Organ Failure Assessment (SOFA) score, and mortality in patients with sepsis and septic shock. Sixty-nine hospitalized adult patients diagnosed with sepsis and septic shock in the internal medicine department, were included in the study after approval of the Clinical Research Ethics Committee. Sepsis diagnosis was based on the detected focus of infection, positive blood cultures, and response to antibiotics. Twenty-one healthy controls matched for age and sex with these patients were also included in the study. Sixty-nine septic patients and twenty-one healthy volunteers were included in the study. Nesfatin-1 levels were compared with covariates. Nesfatin-1 levels in septic patients were lower than that of healthy controls. There was no significant difference in Nesfatin-1 between diabetic and non-diabetic subgroups. Patients with quick Sequential Organ Failure Assessment (qSOFA) score of three had a statistically significantly lower Nesfatin-1 level than those of patients with the score of zero, one, and two. Nesfatin-1 was correlated negatively with C reactive protein. We found a statistically significant difference in 1-month mortality between Nesfatin-1 levels below and over 80pg/mL. In order to use Nesfatin-1 as a biomarker in differentiating sepsis from healthy population, more comprehensive and more studies are needed. If supported by new studies, Nesfatin-1 levels below 80 pg / mL at first admission in septic patients may direct the clinician to broad-spectrum antibiotic therapy and earlier intensive care follow-up.

Keywords

nesfatin-1, sepsis, septic shock

References

1. Oh-I S, Shimizu H, Satoh T, Okada S, Adachi S, Inoue K, et al. Identification of nesfatin-1 as a satiety molecule in the hypothalamus. Nature. 2006 Oct 12;443(7112):709-12. doi: 10.1038/nature05162. Epub 2006 Oct 1. PMID: 17036007.
2. Aydin S. Role of NUCB2/nesfatin-1 as a possible biomarker. Curr Pharm Des. 2013;19(39):6986-92. doi: 10.2174/138161281939131127143422. PMID: 23537082.
3. Stengel A, Hofmann T, Goebel-Stengel M, Lembke V, Ahnis A, Elbelt U, et al. Ghrelin and NUCB2/nesfatin-1 are expressed in the same gastric cell and differentially correlated with body mass index in obese subjects. Histochem Cell Biol. 2013 Jun;139(6):909-18. doi: 10.1007/s00418-013-1087-8. Epub 2013 Mar 21. PMID: 23515787.
4. Heidarzadeh H, Zendehdel M, Babapour V, Gilanpour H. The effect of Nesfatin-1 on food intake in neonatal chicks: role of CRF1 /CRF2 and H1/ H3 receptors. Vet Res Commun. 2018 Mar;42(1):39-47. doi: 10.1007/s11259-017-9706-9. Epub 2017 Dec 26. PMID: 29280084.
5. Maejima Y, Horita S, Kobayashi D, Aoki M, O'hashi R, Imai R, et al. Nesfatin-1 inhibits voltage gated K+ channels in pancreatic beta cells. Peptides. 2017 Sep; 95:10-15. doi: 10.1016/j.peptides.2017.07.001. Epub 2017 Jul 8. PMID: 28697955.
6. Zhang H, Qi C, Li L, Luo F, Xu Y. Clinical significance of NUCB2 mRNA expression in prostate cancer. J Exp Clin Cancer Res. 2013 Aug 16;32(1):56. doi: 10.1186/1756-9966-32-56. PMID: 23958433; PMCID: PMC3751731.
7. Ünal K, Yüksel RN, Turhan T, Sezer S, Yaylaci ET. The association of serum nesfatin-1 and ghrelin levels with metabolic syndrome in patients with schizophrenia. Psychiatry Res. 2018 Mar;261:45-49. doi: 10.1016/j.psychres.2017.12.041. Epub 2017 Dec 20. PMID: 29278806.
8. Akour A, Kasabri V, Boulatova N, Bustanji Y, Naffa R, Hyasat D, et al. Levels of metabolic markers in drug-naive prediabetic and type 2 diabetic patients. Acta Diabetol. 2017 Feb;54(2):163-170. doi: 10.1007/s00592-016-0926-1. Epub 2016 Oct 18. PMID: 27752839.
9. Algul S, Ozkan Y, Ozcelik O. Serum nesfatin-1 levels in patients with different glucose tolerance levels. Physiol Res. 2016 Dec 13;65(6):979-985. doi: 10.33549/physiolres.933186. Epub 2016 Aug 19. PMID: 27539099.
10. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016 Feb 23;315(8):801-10. doi: 10.1001/jama.2016.0287. PMID: 26903338; PMCID: PMC4968574.
11. Cetinkaya H, Karagöz B, Bilgi O, Ozgün A, Tunçel T, Emirzeoğlu L, et al. Nesfatin-1 in advanced lung cancer patients with weight loss. Regul Pept. 2013 Feb 10;181:1-3. doi: 10.1016/j.regpep.2012.11.005. Epub 2012 Dec 23. PMID: 23269222.
12. Jiang G, Wang M, Wang L, Chen H, Chen Z, Guo J, et al. The protective effect of nesfatin-1 against renal ischemia-reperfusion injury in rats. Ren Fail. 2015 Jun;37(5):882-9. doi: 10.3109/0886022X.2015.1015426. Epub 2015 Feb 24. PMID: 25707521.
13. Saldanha JF, Carrero JJ, Lobo JC, Stockler-Pinto MB, Leal VO, Calixto A, et al. The newly identified anorexigenic adipokine nesfatin-1 in hemodialysis patients: Are there associations with food intake, body composition and inflammation? Regul Pept. 2012 Jan 10;173(1-3):82-5. doi: 10.1016/j.regpep.2011.09.010. Epub 2011 Oct 26. PMID: 22036920.
14. Kaukonen KM, Bailey M, Suzuki S, Pilcher D, Bellomo R. Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000-2012. JAMA. 2014 Apr 2;311(13):1308-16. doi: 10.1001/jama.2014.2637. PMID: 24638143.
15. Dombrovskiy VY, Martin AA, Sunderram J, Paz HL. Facing the challenge: decreasing case fatality rates in severe sepsis despite increasing hospitalizations. Crit Care Med. 2005 Nov;33(11):2555-62. doi: 10.1097/01.ccm.0000186748.64438.7b. PMID: 16276180.
16. Winters BD, Eberlein M, Leung J, Needham DM, Pronovost PJ, Sevransky JE. Long-term mortality and quality of life in sepsis: a systematic review. Crit Care Med. 2010 May;38(5):1276-83. doi: 10.1097/CCM.0b013e3181d8cc1d. PMID: 20308885.
17. Epstein L, Dantes R, Magill S, Fiore A. Varying Estimates of Sepsis Mortality Using Death Certificates and Administrative Codes--United States, 1999-2014. MMWR Morb Mortal Wkly Rep. 2016 Apr 8;65(13):342-5. doi: 10.15585/mmwr.mm6513a2. PMID: 27054476.
18. Ou SM, Chu H, Chao PW, Lee YJ, Kuo SC, Chen TJ, et al. Long-Term Mortality and Major Adverse Cardiovascular Events in Sepsis Survivors. A Nationwide Population-based Study. Am J Respir Crit Care Med. 2016 Jul 15;194(2):209-17. doi: 10.1164/rccm.201510-2023OC. PMID: 26808711.
19. Prescott HC, Osterholzer JJ, Langa KM, Angus DC, Iwashyna TJ. Late mortality after sepsis: propensity matched cohort study. BMJ. 2016 May 17;353:i2375. doi: 10.1136/bmj.i2375. PMID: 27189000; PMCID: PMC4869794.
20. Jones TK, Fuchs BD, Small DS, Halpern SD, Hanish A, Umscheid CA, et al. Post-Acute Care Use and Hospital Readmission after Sepsis. Ann Am Thorac Soc. 2015 Jun;12(6):904-13. doi: 10.1513/AnnalsATS.201411-504OC. PMID: 25751120; PMCID: PMC4590016.
21. Prescott HC, Langa KM, Iwashyna TJ. Readmission diagnoses after hospitalization for severe sepsis and other acute medical conditions. JAMA. 2015 Mar 10;313(10):1055-7. doi: 10.1001/jama.2015.1410. PMID: 25756444; PMCID: PMC4760618.
22. Prescott HC, Langa KM, Liu V, Escobar GJ, Iwashyna TJ. Increased 1-year healthcare use in survivors of severe sepsis. Am J Respir Crit Care Med. 2014 Jul 1;190(1):62-9. doi: 10.1164/rccm.201403-0471OC. PMID: 24872085; PMCID: PMC4226030.
23. Knaus WA, Sun X, Nystrom O, Wagner DP. Evaluation of definitions for sepsis. Chest. 1992 Jun;101(6):1656-62. doi: 10.1378/chest.101.6.1656. PMID: 1600787.
24. Peres Bota D, Lopes Ferreira F, Mélot C, Vincent JL. Body temperature alterations in the critically ill. Intensive Care Med. 2004 May;30(5):811-6. doi: 10.1007/s00134-004-2166-z. Epub 2004 Feb 4. PMID: 15127194.
25. Kreger BE, Craven DE, McCabe WR. Gram-negative bacteremia. IV. Re-evaluation of clinical features and treatment in 612 patients. Am J Med. 1980 Mar;68(3):344-55. doi: 10.1016/0002-9343(80)90102-3. PMID: 6987871.
26. Haase N, Ostrowski SR, Wetterslev J, Lange T, Møller MH, Tousi H, et al. Thromboelastography in patients with severe sepsis: a prospective cohort study. Intensive Care Med. 2015 Jan;41(1):77-85. doi: 10.1007/s00134-014-3552-9. Epub 2014 Nov 21. PMID: 25413378.
27. Neyra JA, Canepa-Escaro F, Li X, Manllo J, Adams-Huet B, Yee J, et al; Acute Kidney Injury in Critical Illness Study Group. Association of Hyperchloremia With Hospital Mortality in Critically Ill Septic Patients. Crit Care Med. 2015 Sep;43(9):1938-44. doi: 10.1097/CCM.0000000000001161. PMID: 26154934; PMCID: PMC4537691.
28. Schuetz P, Birkhahn R, Sherwin R, Jones AE, Singer A, Kline JA, et al. Serial Procalcitonin Predicts Mortality in Severe Sepsis Patients: Results From the Multicenter Procalcitonin MOnitoring SEpsis (MOSES) Study. Crit Care Med. 2017 May;45(5):781-789. doi: 10.1097/CCM.0000000000002321. PMID: 28257335; PMCID: PMC5389588.
29. Freund Y, Lemachatti N, Krastinova E, Van Laer M, Claessens YE, Avondo A, et al; French Society of Emergency Medicine Collaborators Group. Prognostic Accuracy of Sepsis-3 Criteria for In-Hospital Mortality Among Patients With Suspected Infection Presenting to the Emergency Department. JAMA. 2017 Jan 17;317(3):301-308. doi: 10.1001/jama.2016.20329. PMID: 28114554.
30. Xu Y, Chen F. Antioxidant, Anti-Inflammatory and Anti-Apoptotic Activities of Nesfatin-1: A Review. J Inflamm Res. 2020 Sep 28;13:607-617. doi: 10.2147/JIR.S273446. PMID: 33061526; PMCID: PMC7532075.

There are 30 citations in total.

Details

Primary Language	English
Subjects	Health Care Administration
Journal Section	Clinical Research
Authors	İlkim Toprak 0000-0002-9320-1252 Hasan Eruzun 0000-0003-0355-1820 Yasin Kutlu 0000-0003-2184-634X Yücel Arman 0000-0002-9584-6644 Pembegül Yumuştutan This is me 0000-0001-9070-7162 Şengül Aydın Yoldemir 0000-0003-4236-1181 Murat Akarsu 0000-0002-2675-4252 Okan Dikker 0000-0002-9153-6139 Tufan Tükek 0000-0002-4237-1163
Early Pub Date	January 3, 2022
Publication Date	January 1, 2022
Submission Date	January 19, 2021
Acceptance Date	May 31, 2021
Published in Issue	Year 2022 Volume: 39 Issue: 1

Cite

APA	Toprak, İ., Eruzun, H., Kutlu, Y., Arman, Y., et al. (2022). Diagnostic and prognostic value of Nesfatin-1 in sepsis and septic shock. Journal of Experimental and Clinical Medicine, 39(1), 1-6.
AMA	Toprak İ, Eruzun H, Kutlu Y, Arman Y, Yumuştutan P, Aydın Yoldemir Ş, Akarsu M, Dikker O, Tükek T. Diagnostic and prognostic value of Nesfatin-1 in sepsis and septic shock. J. Exp. Clin. Med. January 2022;39(1):1-6.
Chicago	Toprak, İlkim, Hasan Eruzun, Yasin Kutlu, Yücel Arman, Pembegül Yumuştutan, Şengül Aydın Yoldemir, Murat Akarsu, Okan Dikker, and Tufan Tükek. “Diagnostic and Prognostic Value of Nesfatin-1 in Sepsis and Septic Shock”. Journal of Experimental and Clinical Medicine 39, no. 1 (January 2022): 1-6.
EndNote	Toprak İ, Eruzun H, Kutlu Y, Arman Y, Yumuştutan P, Aydın Yoldemir Ş, Akarsu M, Dikker O, Tükek T (January 1, 2022) Diagnostic and prognostic value of Nesfatin-1 in sepsis and septic shock. Journal of Experimental and Clinical Medicine 39 1 1–6.
IEEE	İ. Toprak, “Diagnostic and prognostic value of Nesfatin-1 in sepsis and septic shock”, J. Exp. Clin. Med., vol. 39, no. 1, pp. 1–6, 2022.
ISNAD	Toprak, İlkim et al. “Diagnostic and Prognostic Value of Nesfatin-1 in Sepsis and Septic Shock”. Journal of Experimental and Clinical Medicine 39/1 (January 2022), 1-6.
JAMA	Toprak İ, Eruzun H, Kutlu Y, Arman Y, Yumuştutan P, Aydın Yoldemir Ş, Akarsu M, Dikker O, Tükek T. Diagnostic and prognostic value of Nesfatin-1 in sepsis and septic shock. J. Exp. Clin. Med. 2022;39:1–6.
MLA	Toprak, İlkim et al. “Diagnostic and Prognostic Value of Nesfatin-1 in Sepsis and Septic Shock”. Journal of Experimental and Clinical Medicine, vol. 39, no. 1, 2022, pp. 1-6.
Vancouver	Toprak İ, Eruzun H, Kutlu Y, Arman Y, Yumuştutan P, Aydın Yoldemir Ş, Akarsu M, Dikker O, Tükek T. Diagnostic and prognostic value of Nesfatin-1 in sepsis and septic shock. J. Exp. Clin. Med. 2022;39(1):1-6.

Download Cover Image

Article Files

Full Text

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.