Abstract
OBJECTIVE: The study aimed to investigate the role of TNFα-308 genetic polymorphism, association between TNF-α serum level and prognostic factor of mortality in pediatric sepsis. 
 
 METHODS: This was a prospective cohort study. Consecutive sampling method was used and samples were obtained from septic patients diagnosed based on the IPSC 2005 criteria. Serum TNF-α and genetic polymorphism were measuread and analyzed with ELISA and PCR plus sequencing, respectively.
 
 RESULT: One hundred and seventeen samples were included, 62 were in survivor grioup and 55 in non survivor group. A very significant association was found between TNF-α serum level and mortality (p<0.001). The optimal cut off point of TNFα serum level as prognostic factor for mortality was ≥ 500 pg/mL (p<0.001 and OR 16.6) sensitivity 78.1%, specificity 82%, Positive Predictive Value (PPV) 79.6%, Negative Predictive Value (NPV) 80.9%, Area Under Curve (AUC) 0.811. Two samples showed TNFα-308A polymorphism and mutation of GG allele to heterozygote GA allele. Neither TNFα polymorphism and TNFα serum level showed any association with mortality. There was no significant association between TNFα-308 polymorphism and TNF-α serum level p=0.461(p>0.05) and mortality p=0.219 (p>0.05), all sample who had TNFα-308 genetic polymorphism were in non survivor group and had TNF-α serum level ≥ 500 pg/mL. 
 
 CONCLUSION: Genetic polymorphism of TNF-α-308 showed no statistic significant on mortality, but all subjects with TNFα-308 polymorphism had higher TNF-α serum and were all in non-survivor group.
Highlights
Sepsis, which is usually caused by infection can lead to severe systemic inflammation
The optimal cut off point of TNFα serum level as prognostic factor for mortality was ≥ 500 pg/mL (p
There was no significant association between TNFα-308 polymorphism and TNF-α serum level p=0.461(p>0.05) and mortality p=0.219 (p>0.05), all sample who had TNFα-308 genetic polymorphism were in non survivor group and had TNF-α serum level ≥ 500 pg/mL
Summary
Consecutive sampling method was used and samples were obtained from septic patients diagnosed based on the IPSC 2005 criteria. Serum TNF-α and genetic polymorphism were measuread and analyzed with ELISA and PCR plus sequencing, respectively
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