Abstract
We performed a prospective study to evaluate the abilities of inflammatory cytokines to rule out the potential risk of sepsis and intracranial infection and to estimate the function of inflammatory cytokines in discriminating Gram-negative bacteria from Gram-positive ones through ROC analysis. During the course of the study, Levels of serum inflammatory cytokines were measured by flow cytometry at the onset of diseases of patients who suffered from sepsis or intracranial infection. A total of 299 cases of sepsis and 43 cases of intracranial infection were observed during the study. It is noticed that there is no difference of inflammatory cytokine levels between sepsis group and intracranial infection group. The area under ROC curve (AUC) of cytokines, such as IL-2, IL-6 and IL-10 were 0.901, 0.86, 0.888, respectively, which was employed to rule out the diseases of sepsis and intracranial infection. Through comparisons with the patients who were infected by Gram-positive bacteria or Gram-negative ones, it is estimated that IL-6 and IL-10 sharply elevated in patients with Gram-negative bacteria infection (median levels, pg/mL: IL-6: 116.6 vs. 25.4, P = 0.000; IL-10: 13.7 vs. 6.3, P = 0.000). Additionally, IL-2 significantly decreased when patients suffered from Gram-negative bacteria infection (median levels, pg/mL: IL-2: 2.2 vs. 2.7, P = 0.031). The AUCs for detecting cytokines, including IL-2, IL-10 and LOGREGR.Pred_IL-2+IL-10 were 0.581 (95% CI, 0.526 to 0.634), 0.661 (95% CI, 0.608 to 0.712) and 0.735 (95% CI, 0.685 to 0.782), respectively, which was used to evaluate the function of inflammatory cytokines in discriminating Gram-negative bacteria from Gram-positive ones infection. This paper indicates that IL-2, IL-6 and IL-10 are effective biomarkers to rule out sepsis and intracranial infection. Additionally, the combination of IL-2 and IL-10 is an effective biomarkers to diagnose whether patients afflicted by Gram-negative bacteria.
Highlights
Children with sepsis have a higher mortality than those without sepsis [1]
Lower had a sensitivity of 100.0% and a specificity of 71.0% to rule out sepsis and intracranial infection (Youden index J: 0.7104); a serum IL-10 level equal to 3.6 pg/mL or lower had a sensitivity of 90.9% and a specificity of 79.1% to rule out sepsis and intracranial infection (Youden index J: 0.7001)
area under Receiver operating characteristic (ROC) curve (AUC) for LOGREGRÐ Pred_IL-2+IL-10 was bigger than IL-2 or IL-10 alone and its specificity was better indicating that the combination of IL-2 and IL-10 was a more effective biomarker in predicting gram-negative bacteria (GNB) and its specificity in prediction of GNB infection were better than Creactive protein (CRP), which showed similar power to predict
Summary
Children with sepsis have a higher mortality than those without sepsis [1]. In Italy, in paediatric intensive care units severe sepsis and septic shock have a mortality rate of 17.7% and 50.8%, respectively [2]. 1995 and 2005, the prevalence of severe sepsis in newborns had more than doubled, from 4.5 to 9.7 cases per 1,000 births [3]. Bacteria are the most common cause of severe sepsis in children [4,5]. As a result of the low positive rate and long duration, microbiologic culture is not sensitive enough for the early detection of bacteria in febrile patients. Even though the results of suffering microbiological infection are positive, clinicians still need to be aware of whether the results are false or not, to preclude the mixed infection or of environmental contamination
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