Abstract
It has been established that the innate and adaptive immune suppression was heterogeneous in septic and nonseptic critically ill patients, while the value of immune function in pediatric patients with nonseptic critical illness is limited. We conducted a single-center retrospective study to explore this issue. A total of 65 children with nonseptic illnesses were studied for lymphocyte subpopulations, immunoglobulin concentrations, complement concentrations, and cytokines in peripheral blood in the next 72 hours after admission to our Pediatric Intensive Care Unit (PICU). When compared to clinically recovered patients, patients with disease progression had a numerically lower but not significantly different median pediatric critical illness score and longer PICU median stays. The analysis of serum immunoglobulin (IgG, IgM, and IgA), serum complement (C3, C4) concentrations, and lymphocyte subpopulations showed no significantly difference between patients with and without relieved clinical symptoms by day 4. For the cytokine analysis, the level of IL-6 was significantly higher in patients with disease progression than that in patients who clinically recovered (p = 0.046). In the univariate Cox regression analysis, plasma IL-6 levels were associated with outcome. Multivariate analysis evidenced that the level of plasma IL-6 was one of the factors determining the length of hospital stays. In conclusions, our results demonstrate that increased IL-6 levels in the initial 72 hours post admission are associated with prolonged stays and disease progression in nonseptic critically ill children in the PICU.
Highlights
The immune system plays an important role in the acute phase of critical illness, as well as in late stage disease progression
During the period of July 2018 to July 2019, a total of 345 pediatric patients were admitted to our Pediatric Intensive Care Unit (PICU), 286 patients fulfilled the inclusion criteria above specified, and immune function including evaluation of lymphocyte subset count, plasma levels of immunoglobulins, and plasma cytokine concentrations was performed in 65 patients
The evaluation of immune suppression in critically ill pediatric patients has been previously studied in sepsis [15], but very little data is available on pediatric patients without sepsis
Summary
The immune system plays an important role in the acute phase of critical illness, as well as in late stage disease progression. Critical illness-induced immune suppression has been demonstrated in children with a variety of diagnoses, including sepsis [1], trauma [2], and cardiopulmonary bypass [3]. Acute bronchopneumonia was the most common disease in the PICU and the main causes of death included severe acute bronchial pneumonia, severe sepsis, complex congenital heart disease, severe cerebral trauma, respiratory failure, severe hand-foot-mouth disease, acute poisoning, and circulatory failure in China [12]. It suggested that the majority of critically ill children suffered from nonseptic disease in the PICU. The relationship between immune function and the prognosis of nonseptic critical illness in pediatric patients is poorly known yet
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