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Relation between cytokines and routine laboratory data in children with septic shock and purpura
J A Hazelzet1, E van der Voort, J Lindemans
1Department of Pediatrics, Sophia Children's Hospital, Erasmus University, Rotterdam, The Netherlands.
Insights
In pediatric severe infectious purpura, lactate, tumor necrosis factor (TNF), and interleukin-6 (IL-6) levels correlate with disease severity. These markers, along with C-reactive protein (CRP) and PRISM scores, offer prognostic value for survival.
Area of Science:
- Pediatric critical care medicine
- Infectious disease immunology
- Biomarker research
Background:
- Severe infectious purpura in children is a life-threatening condition.
- Early identification of prognostic markers is crucial for timely intervention.
- Cytokines and routine laboratory tests are potential indicators of disease severity.
Purpose of the Study:
- To investigate the relationship between routine laboratory markers (lactate, fibrinogen, C-reactive protein) and cytokine levels (TNF, IL-1, IL-6) in pediatric patients with severe infectious purpura.
- To assess the prognostic value of these markers on patient admission for predicting outcomes.
Main Methods:
- A prospective study was conducted in a Pediatric Intensive Care Unit (PICU).
- Seventeen children (aged 5-172 months) with severe infectious purpura were enrolled.
- Blood samples were analyzed for lactate, CRP, fibrinogen, TNF, IL-1, and IL-6; PRISM scores were recorded.
Main Results:
- Lactate, TNF, and IL-6 levels significantly differed across shock severity groups (non-shock, shock, severe shock).
- Fibrinogen, CRP, IL-1, and PRISM scores distinguished between survivors and non-survivors.
- Strong correlations were observed between cytokines, PRISM scores, and lactate levels.
Conclusions:
- Cytokine levels, particularly TNF and IL-6, are significantly correlated with lactate levels in pediatric severe infectious purpura.
- Lactate, TNF, and IL-6 are closely associated with the severity of septic shock in these patients.
- These markers hold prognostic value for children with severe infectious purpura.
Objective:
To establish the relation between routine laboratory data (lactate, fibrinogen, CRP) and cytokines (TNF,IL-1 and -6) and to estimate their prognostic value in pediatric patients with severe infectious purpura on admission.
Design:
Prospective study.
Setting:
Pediatric intensive care unit (PICU).
Patients:
17 children aged 5-172 months (median 46) were hospitalized in our PICU in 1989-90 with severe infectious purpura. Neisseria meningitidis was isolated in 15 children and Haemophilus influenzae in two. The patients were divided into 3 groups: non-shock, shock and severe shock leading to death. Shock was defined by standard criteria.
Measurements:
Arterial blood was sampled for lactate, CRP, fibrinogen, TNF, and IL-1 and -6 on admission. The PRISM (pediatric risk of morality)-score was recorded.
Methods:
Statistical analysis was performed with the Student's t-test using the logarithmic values of the cytokine concentration, and Spearman correlation analysis.
Results:
According to the shock criteria, 9 patients were in shock of whom 4 did not survive. Significant differences existed between the 3 groups concerning lactate, TNF, and IL-6. Fibrinogen, CRP, IL-1, and PRISM-score discriminated only between survivors and non-survivors. A highly significant correlation existed between cytokines, the PRISM-score and lactate (TNF: r = 0.69, IL-1: r = 0.56, IL-6: r = 0.65, PRISM: r = 0.65). A significant inverse correlation existed between cytokines and CRP (TNF: r = -0.55, IL-1: r = -0.64, and IL-6: r = -0.56), and IL-6 and fibrinogen (r = -0.65).
Conclusion:
These results show a significant correlation between cytokines and lactate, and lactate, TNF and IL-6 are closely associated with the severity of septic shock with purpura in children.