Related Experiment Videos
Endotoxin, cytokines and lipid peroxides in children with intussusception
I E Willetts1, P Kite, G R Barclay
1Department of Paediatric Surgery, Leeds Teaching Hospitals NHS Trust, UK.
Insights
Pediatric intussusception involves elevated inflammatory markers like C-reactive protein (CRP). CRP levels correlate with disease severity, aiding in clinical outcome prediction for this common surgical emergency.
Area of Science:
- Pediatric Surgery
- Immunology
- Biochemistry
Background:
- Intussusception is a frequent pediatric surgical emergency.
- Understanding inflammatory responses is crucial for managing intussusception.
Purpose of the Study:
- Investigate inflammatory mediators in children with acute intussusception.
- Identify plasma markers for predicting clinical outcomes.
Main Methods:
- Prospective data collection on clinical, radiographic, operative, and pathological details.
- Analysis of plasma samples for malondialdehyde, CRP, IL-6, neopterin, TNF-alpha, endotoxin, and IgG/IgM antiendotoxin antibodies.
- Comparison of acute and convalescent blood samples.
Main Results:
- Elevated plasma levels of IL-6, neopterin, and CRP in acute intussusception compared to convalescent samples.
- CRP identified as the most effective variable for differentiating treatment groups.
- Increased IgM antiendotoxin core antibody (EndoCAb) concentrations in convalescent sera.
Conclusions:
- Childhood intussusception is linked to endotoxemia and increased circulating inflammatory cytokines.
- Plasma CRP levels at diagnosis correlate positively with disease severity.
- CRP shows potential as a biomarker for intussusception severity.
Background:
Intussusception is a relatively common paediatric surgical emergency. The aim of this study was to investigate selected inflammatory mediators in children with acute intussusception and to identify potentially useful plasma markers of clinical outcome.
Methods:
Clinical, radiographic, operative and pathological details were recorded prospectively of all children presenting to a single institution with a confirmed diagnosis of acute intussusception during 1 year. Paired acute and convalescent venous blood samples were collected in a standard manner for blinded analysis of the following: malondialdehyde, C-reactive protein (CRP), interleukin (IL) 6, neopterin, tumour necrosis factor alpha, endotoxin, and immunoglobulin (Ig) G and IgM antiendotoxin core antibody (EndoCAb).
Results:
Thirty-two consecutive children (23 boys, nine girls) with a median age of 4 months were studied. Acute ileocolic intussusception was managed by air enema reduction (n = 19), operative reduction (n = 8) or surgical resection (n = 5). Peripheral blood cultures were sterile. Acute levels of plasma IL-6, neopterin and CRP were significantly raised in comparison to both normal laboratory ranges and convalescent samples (P < 0.001). Using stepwise discriminant analysis, CRP was identified as the best variable at distinguishing between the three treatment groups (P < 0.001). IgM EndoCAb concentrations were significantly greater in the convalescent sera of all the patients (P < 0.001).
Conclusion:
Acute ileocolic intussusception in childhood is associated with endotoxinaemia and significantly raised levels of circulating inflammatory cytokines. Plasma CRP at diagnosis showed a statistically significant positive correlation with disease severity.