Interleukin-27 as a candidate diagnostic biomarker for bacterial infection in immunocompromised pediatric patients
Lauren Jacobs1, Zachary Berrens2, Erin K Stenson3
1Department of Pediatrics, Division of Pediatric Critical Care, Texas Children's Hospital, Houston, Texas, United States of America.
Insights
Interleukin-27 (IL-27) and procalcitonin (PCT) did not prove reliable for diagnosing bacterial infections in immunocompromised children. Further research is needed to find effective biomarkers for this vulnerable pediatric population.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Biomarkers
- Immunocompromised Patients
Background:
- Immunocompromised children are highly susceptible to bacterial infections.
- Early diagnosis and treatment are critical for this population.
- Interleukin-27 (IL-27) and procalcitonin (PCT) have been proposed as potential biomarkers.
Purpose of the Study:
- To evaluate the diagnostic accuracy of IL-27 and PCT in identifying bacterial infections in immunocompromised pediatric patients.
- To compare the utility of IL-27 and PCT as biomarkers for bacterial infection.
Main Methods:
- A single-center prospective cohort study was conducted at Cincinnati Children's Hospital Medical Center.
- 293 immunocompromised pediatric patients with suspected bacterial infection were enrolled.
- The diagnostic performance of IL-27 and PCT was assessed using receiver operating characteristic (ROC) curve analysis.
Main Results:
- The study included 400 episodes of suspected bacterial infection in 293 patients, with an overall infection rate of 37%.
- Area Under the Curve (AUC) values for diagnosing bacterial infection were 0.62 for IL-27 and 0.65 for PCT.
- IL-27 showed 94% specificity but only a 64% negative predictive value at a cutoff of 5.0 ng/mL.
Conclusions:
- The study failed to validate IL-27 and PCT as reliable biomarkers for bacterial infection in immunocompromised pediatric patients.
- Developing accurate biomarkers for bacterial infections in this vulnerable population remains a significant challenge.
Background:
Immunocompromised pediatric patients constitute a growing population that is particularly vulnerable to bacterial infection, necessitating prompt recognition and treatment. This study assessed the utility of interleukin-27 (IL-27) and procalcitonin (PCT) as biomarkers of bacterial infection among immunocompromised pediatric subjects.
Methods:
This is a single-center prospective cohort study conducted from July 2016 through September 2017, drawing subjects from the inpatient units at Cincinnati Children's Hospital Medical Center (CCHMC), a large, tertiary care children's hospital. Patients were included if they fit the definition of immunocompromised and were under clinical suspicion for infection, defined by the acquisition of a blood culture at any point during the admission. The primary analysis assessed the accuracy of IL-27 to diagnose bacterial infection in immunocompromised pediatric patients, using PCT as a comparator.
Results:
293 patients were recruited, representing 400 episodes of suspected bacterial infection. The median age was 7.8 years (IQR 3.1-13.8 years). Fifty-three percent (n = 213) of the population had a primary oncologic diagnosis, 24% (n = 95) had received a bone marrow transplant, and 21% (n = 85) had received a solid organ transplant. The overall infection rate was 37%, with 70% of those patients having some form of culture positivity. Twenty-eight-day mortality was 5%, 60-day mortality was 9%, with 87% of patients surviving to hospital discharge. The AUC's of the ROC curve to diagnose bacterial infection were 0.62 (0.5-0.68) for IL-27 and 0.65 (0.6-0.73) for PCT. Using the previously determined cutoff of 5.0 ng/mL, the specificity of IL-27 to diagnose bacterial infection reached 94%, with a negative predictive value of 64%.
Conclusions:
Despite prior work demonstrating IL-27 and PCT as possible biomarkers of bacterial infection in immunocompromised pediatric patients, we were unable to validate these findings. This illustrates the challenges associated with developing reliable biomarkers of bacterial infection in this vulnerable population.
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