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Innate immune function and mortality in critically ill children with influenza: a multicenter study
Mark W Hall1, Susan M Geyer, Chao-Yu Guo
1Department of Pediatrics, Critical Care Medicine, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA. Mark.Hall@NationwideChildrens.org
Critical Care Medicine
|December 11, 2012
Summary
Critically ill children with influenza and high cytokine levels often have immune suppression, increasing mortality risk. Early immune suppression, especially with Staphylococcus aureus coinfection, predicts death in pediatric influenza patients.
Area of Science:
- Pediatric critical care medicine
- Immunology
- Infectious diseases
Background:
- Influenza infection in children can lead to critical illness.
- Understanding the immune response is crucial for predicting outcomes.
Purpose of the Study:
- To investigate the link between serum cytokine levels, immune function, and mortality in critically ill children with influenza.
- To assess the feasibility of multicenter innate immune function testing.
Main Methods:
- A prospective, multicenter observational study involving 15 pediatric ICUs.
- Measured serum cytokine levels and ex vivo tumor necrosis factor-α production in 52 critically ill children and 21 controls.
- Assessed secondary infections, particularly Staphylococcus aureus.
Main Results:
- High serum cytokine levels (e.g., IL-6, TNF-α) and Staphylococcus aureus coinfection were associated with increased mortality.
- Nonsurvivors exhibited immunosuppression with reduced tumor necrosis factor-α production capacity.
- Low tumor necrosis factor-α response (<250 pg/mL) predicted death and longer ICU stays.
Conclusions:
- Critical influenza in children can present with both high cytokines and immune suppression.
- Early, severe innate immune suppression is linked to Staphylococcus aureus coinfection and mortality.
- Multicenter immune function testing can identify high-risk pediatric patients.
