Profile Tumor Necrosis Factor Alpha and Procalcitonin in Preeclampsia and Preeclampsia with Sepsis

Abstract

BACKGROUND: Preeclampsia is hypertension in pregnancy which are characterized by high blood pressure, proteinuria that occur after 20 weeks of GA. Preeclampsia remains a massive cause of maternal morbidity and mortality that 50.000 death annually. The cause of preeclampsia is still unclear but there is a possibility caused by immunological processes in micro placenta environment during the  early age of pregnancy. It is suggested that cytokines such as tumor necrosis factor (TNF-α) has an important role in the pathogenesis of preeclampsia. Preeclampsia is an extreme feature of the systemic inflammatory response during pregnancy. Systemic inflammation in preeclampsia can cause organ damage and induce sepsis. The pathophysiology is initiated by a high level of pro-inflammatory cytokine that released by peripheral  blood mononuclear cell (PBMC). Beside pro-inflammatory cytokine, the marker of sepsis can be shown by procalcitonin (PCT) that produced by PBMC which is activated by TNF-α. AIM: The objective of the study is to evaluate profile maternal plasma levels of TNF-α and PCT and analyze their correlation in normotensive pregnant woman, preeclamptic and preeclampsia with sepsis. METHODS: An observational cross-sectional study. The sample were normotensive, preeclamptic, and preeclamptic with sepsis (n = 18) in Bangil  Hospital, Pasuruan. The level of TNF-α  and PCT was measured by ELISA. The statistical analysis with SPSS 18.0 with p < 0.05. RESULTS: This study showed level of TNF-α and PCT in preeclamptic with sepsis was significantly higher than control (p < 0.05) and not a  significant difference in preeclampsia (p > 0.05). The level of TNF-α  and PCT in preeclampsia compared with control was not a significant difference (p > 0.05). This study showed there was no correlation between TNF-α and PCT in patients with preeclampsia with sepsis. CONCLUSION: The  plasma  level  of  TNF-α  and  PCT was  statistically different between the  control  group, preeclampsia and preeclampsia with sepsis. There was no significant difference of TNF-α and PCT plasma level in preeclampsia with sepsis than preeclampsia group. There was no significant correlation between preeclampsia in woman and preeclampsia with sepsis in maternal plasma TNF-α and PCT levels.