Abstract
BackgroundTo identify markers for earlier diagnosis of severe pneumonia, we assess the correlation between serum cytokine profile of children with different pneumonia severity.MethodsIn 25 hospitalized children, 7 with mild pneumonia and 18 with severe pneumonia, the serum concentration of 11 cytokines in three sampling times were dosed. Statistical analysis included parametric and non-parametric tests, Pearson correlation and ROC curve for cut-off definition of cytokines.ResultsAt admission, IL-6 serum levels were high in mild or severe pneumonia, and was associated to vomiting (P = 0.019) in both groups; and also to dyspnea (P = 0.012) and white blood cell count (P = 0.045) in patients with severe pneumonia. IL-10 levels were also high in patients with pneumonia and were associated to lymphocytosis (P = 0.025). The ROC curve of the IL-6:IL-10 serum levels ratio discriminated severe pneumonia cases at admission, and persistence of infection in the third day of antibiotic therapy, with positive predictive values of 93% and 89%, respectively.ConclusionsThe balance between IL-6 and IL-10 serum levels showed to be a more discriminative marker for severity definition and evaluation of recovery in patients with pneumonia.Electronic supplementary materialThe online version of this article (doi:10.1186/s12890-016-0324-z) contains supplementary material, which is available to authorized users.
Highlights
To identify markers for earlier diagnosis of severe pneumonia, we assess the correlation between serum cytokine profile of children with different pneumonia severity
The de Brito et al BMC Pulmonary Medicine (2016) 16:170 cytokines IL-1, tumor necrosis factor (TNF) and IL-6 are important for the acute phase response [7, 9, 25], while modulation of inflammatory responses of the airways is related to the expression of the anti-inflammatory cytokines,IL-10 and IL-4 [6, 8, 24]
Most studies that seek to relate the severity of acute respiratory disease with cytokines serum levels have evaluated cytokine levels in a single time point and samples were collected from adult patients, who may have different inflammatory responses from those observed in children due to the anatomical-functional differences of the pulmonary alveoli, in addition to the immune system immaturity [7, 9,10,11,12,13, 21, 26]
Summary
To identify markers for earlier diagnosis of severe pneumonia, we assess the correlation between serum cytokine profile of children with different pneumonia severity. Most studies that seek to relate the severity of acute respiratory disease with cytokines serum levels have evaluated cytokine levels in a single time point and samples were collected from adult patients, who may have different inflammatory responses from those observed in children due to the anatomical-functional differences of the pulmonary alveoli, in addition to the immune system immaturity [7, 9,10,11,12,13, 21, 26]. The aim of the present study was to evaluate the correlation between the cytokines profile in the serum of children and adolescents with different pneumonia severity, defined by clinical manifestations and alterations in the blood count, in order to identify markers for early diagnosis of severe pneumonia
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