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Host Inflammatory Biomarkers of Disease Severity in Pediatric Community-Acquired Pneumonia: A Systematic Review and
Catarina D Fernandes1,2,3, María B Arriaga1,2,4, Maria Carolina M Costa1,2,5
1Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil.
Insights
Biomarkers like C-reactive protein (CRP), IL-6, IL-8, and procalcitonin can help identify severe community-acquired pneumonia (CAP) in children. These markers show increased levels in severe CAP cases, aiding clinical decisions.
Area of Science:
- Pediatric infectious diseases
- Biomarker discovery
- Clinical diagnostics
Background:
- Community-acquired pneumonia (CAP) is a leading cause of child mortality globally.
- Accurate severity assessment is crucial for effective clinical management of pediatric CAP.
- Identifying reliable biomarkers can aid in developing quantitative scoring systems for CAP severity.
Purpose of the Study:
- To systematically review and meta-analyze the association between host inflammatory biomarkers and CAP severity in children.
- To evaluate the potential of various serum biomarkers in predicting severe CAP.
- To inform clinical decision-making for pediatric CAP management.
Main Methods:
- Systematic review and meta-analysis of studies from PubMed and EMBASE.
- Inclusion of case-control, cross-sectional, and cohort studies examining serum biomarkers.
- Extraction and analysis of biomarker levels (means, SMDs) and disease severity data.
Main Results:
- Seventeen studies involving 272 abstracts were included in the analysis.
- Significantly elevated levels of C-reactive protein (CRP), IL-6, IL-8, neutrophil count, and procalcitonin were observed in severe CAP.
- Conversely, IL-2 concentrations were higher in nonsevere CAP cases.
Conclusions:
- Host inflammatory biomarkers, particularly CRP, IL-6, IL-8, and procalcitonin, show promise in predicting severe CAP in pediatric populations.
- These biomarkers can potentially be integrated into clinical practice to improve the management of severe pediatric CAP.
- Further research may refine the use of these biomarkers for quantitative severity scoring.
Background:
Community-acquired pneumonia (CAP) is the leading cause of death in children. Identification of reliable biomarkers offers the potential to develop a severity quantitative score to assist in clinical decision-making and improve outcomes.
Methods:
A systematic review and meta-analysis was performed in PubMed and EMBASE on November 13, 2018, to examine the association between host inflammatory biomarkers and CAP severity in children. The inclusion criteria were case-control, cross-sectional, and cohort studies that examined candidate serum biomarkers. We extracted outcomes of interest, means, and standardized mean differences (SMDs) of plasma and serum levels of biomarkers together with information on disease severity. Meta-analysis was performed. This review was registered in the PROSPERO international registry (CRD42019123351).
Results:
Two hundred seventy-two abstracts were identified, and 17 studies were included. Among the biomarkers evaluated, levels of C-reactive protein (CRP; SMD, 0.63; 95% confidence interval [CI], 0.35 to 0.91), interleukin (IL)-6 (SMD, 0.46; 95% CI, 0.25 to 0.66), IL-8 (SMD, 0.72; 95% CI, 0.15 to 1.29), neutrophil count (SMD, 0.27; 95% CI, 0.07 to 0.47), and procalcitonin (SMD, 0.68; 95% CI, 0.20 to 1.15) were substantially increased in severe CAP. In contrast, IL-2 concentrations (SMD, -0.24; 95% CI, -0.45 to -0.03) were higher in nonsevere CAP. Study heterogeneity was reported to be high (I 2 > 75%), except for IL-2, IL-5, IL-6, and IL-12p70, which were classified as moderate (I 2 = 50%-74%). Only neutrophil and white blood cell counts were described by studies exhibiting a low level of heterogeneity.
Conclusions:
Our results suggest that host biomarkers, and especially CRP, IL-6, IL-8, and procalcitonin levels, have the potential to predict severe CAP in pediatric populations.
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