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Clinical characteristics and cytokine changes in children with pneumonia requiring mechanical ventilation
Thuy Nguyen Thi Dieu1, An Pham Nhat1, Timothy J Craig2
11 Department of Immunology, Allergology and Rheumatology, National Hospital of Paediatrics, Hanoi Medical University, Hanoi, Vietnam.
Insights
Severe pneumonia in children requiring mechanical ventilation is linked to elevated Interleukin-6 (IL-6). High IL-6 levels in these young patients indicate a higher risk of mortality.
Area of Science:
- Pediatric critical care medicine
- Immunology
- Respiratory medicine
Background:
- Severe pneumonia is a leading cause of mortality in children under five.
- Mechanical ventilation is often required for severe cases, indicating critical illness.
- Cytokines play a crucial role in the inflammatory response during pneumonia.
Purpose of the Study:
- To investigate the clinical characteristics and cytokine profiles of children with severe pneumonia requiring ventilatory support.
- To compare cytokine levels in patients with severe pneumonia to healthy controls.
- To explore the association between specific cytokine levels and mortality in this pediatric population.
Main Methods:
- Prospective, descriptive, cross-sectional study design.
- Inclusion of children under five with severe pneumonia requiring mechanical ventilation and age-matched healthy controls.
- Analysis of serum and endotracheal fluid cytokine levels (IL-6, IL-8, GM-CSF, IL-10) using flow cytometry-assisted immunoassay.
Main Results:
- Significantly elevated serum levels of Interleukin-6 (IL-6), IL-8, and Granulocyte/Macrophage Colony-Stimulating Factor (GM-CSF) were observed in children with severe pneumonia compared to controls.
- Serum IL-10 levels were higher in younger infants (<6 months) within the severe pneumonia group.
- Higher serum IL-6 concentrations were significantly associated with mortality in children with severe pneumonia requiring mechanical ventilation.
Conclusions:
- Elevated IL-6 is a potential biomarker for mortality in pediatric severe pneumonia requiring mechanical ventilation.
- Cytokine profiles differ between severe pneumonia patients and healthy children, and also within different age groups of affected children.
- Further research into cytokine-targeted therapies may be warranted for severe pediatric pneumonia.
Abstract:
Objective To assess clinical characteristics and cytokine levels in children with severe pneumonia who required ventilatory support. Methods In this prospective, descriptive, cross-sectional study, blood and endotracheal fluid samples were obtained from patients with severe pneumonia, aged <5 years, within 24 h following intubation. Blood samples were also obtained from age-matched healthy controls. Cytokine levels were investigated using flow cytometry-assisted immunoassay. Results Forty-five patients with severe pneumonia requiring mechanical ventilation (aged 10 ± 5 months) and 35 healthy age-matched controls were included. Patients with severe pneumonia had significantly increased serum interleukin (IL)-6, IL-8, and granulocyte/macrophage colony-stimulating factor concentrations compared with controls (80.84 pg/ml versus 2.06 pg/ml, 90.03 pg/ml versus 6.62 pg/ml, and 115.58 pg/ml versus 11.47 pg/ml, respectively). In the severe pneumonia group, serum IL-10 levels were significantly higher in patients aged <6 months versus those aged 6-12 months. Age-group differences in serum cytokine levels did not correspond to age-group differences in endotracheal-fluid cytokine levels. Serum IL-6 levels were significantly higher in patients who subsequently died versus those who survived (267.12 pg/ml versus 20.75 pg/ml, respectively). Conclusion High IL-6 concentrations were associated with mortality in patients <5 years of age with severe pneumonia requiring mechanical ventilation.
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