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Lipopolysaccharide (LPS)-Induced Tumor Necrosis Factor-Alpha (TNF-ɑ) Levels and Health Care Associated Infection
Shiva Manwatkar1, Anil Kumar Saroj1, Sandip Kumar2
1Division of Pediatric Intensive Care & Pulmonology, Department of Pediatrics, IMS BHU, Varanasi, UP, India.
Insights
This study found that lower levels of tumor necrosis factor-alpha (TNF-α) in children with multi-organ dysfunction syndrome (MODS) were associated with health care associated infections (HAI) and poorer outcomes, including mortality.
Area of Science:
- Pediatric Critical Care Medicine
- Immunology
- Infectious Diseases
Background:
- Multi-organ dysfunction syndrome (MODS) is a critical condition in children.
- Tumor necrosis factor-alpha (TNF-α) plays a role in inflammation and infection.
- Health care associated infections (HAI) are common complications in critically ill children.
Purpose of the Study:
- To investigate the relationship between lipopolysaccharide (LPS)-induced TNF-α levels and HAI in children with MODS.
- To determine the association of TNF-α levels with the duration of MODS and patient survival.
Main Methods:
- LPS-induced TNF-α levels were measured in 67 children with MODS on day 3.
- Data collected included Pediatric Index of Mortality (PIM-3), cultures, diagnosis, HAI status, MODS duration, and survival outcomes.
- Statistical analysis compared TNF-α levels between different patient groups.
Main Results:
- 94% of children with MODS exhibited reduced TNF-α levels (<200 pg/ml).
- Lower TNF-α levels were significantly associated with prolonged MODS (≥7 days), development of HAI (especially ventilator-associated pneumonia), and non-survival.
- Health care associated infection (HAI) was independently linked to reduced TNF-α levels (p=0.01).
Conclusions:
- Reduced TNF-α levels are a potential biomarker for increased risk of HAI and adverse outcomes in pediatric MODS.
- The findings suggest an important role for TNF-α in the pathogenesis of MODS and its complications.
- Further research could explore therapeutic strategies targeting TNF-α to improve outcomes in these critically ill children.
Abstract:
The present study estimated lipopolysaccharide (LPS)-induced tumor necrosis factor-alpha (TNF-α) levels and its association with health care associated infection (HAI) and duration of multi-organ dysfunction syndrome (MODS). LPS-induced TNF-α levels were estimated in 67 children on day 3 of MODS. Variables recorded were Pediatric Index of Mortality (PIM-3), cultures, diagnosis, HAI, days of MODS, survivors and non-survivors. Of 67 children, 37 (52.2%) were male and 27 (40.2%) expired. Sixty-three (94%) children had reduced TNF-α levels (<200 pg/ml); 23.11 (10.38, 40.59). The median number of days in MODS was 7 (5, 12) and prolonged MODS (≥7 d) was observed in 49/67 (73.1%) children. Forty-five (67.1%) children had HAI, among these 33/45 (73.3%) had ventilator associated pneumonia (VAP). TNF-α levels were significantly lower in children with MODS, prolonged MODS, children who developed HAI and non-survivors as compared to healthy children (p <0.0001), children with MODS <7 d (p=0.01), children without HAI (p=0.009) and survivors (p=0.04), respectively. HAI was independently associated with reduced levels of TNF-α (p=0.01).
