Comparison of interleukin-6, interleukin-10, procalcitonin and C-reactive protein in identifying high-risk febrile illness in pediatric cancer patients: A prospective observational study
Comparison of interleukin-6, interleukin-10, procalcitonin and C-reactive protein in identifying high-risk febrile illness in pediatric cancer patients: A prospective observational study
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白细胞介素 6、白细胞介素 10、降钙素原和 C 反应蛋白在儿童癌症患者高危发热性疾病识别中的比较：一项前瞻性观察研究
DOI：
10.1016/j.cyto.2019.01.004
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发表时间：
2019-04-01
期刊：
影响因子：
3.8
通讯作者：
Tang, Yong-Min
中科院分区：
文献类型：
--
作者：
Xu, Xiao-Jun;Luo, Ze-Bin;Tang, Yong-Min
本研究的目的是系统比较 C 反应蛋白 (CRP)、降钙素原 (PCT) 和血清细胞因子在识别高危感染儿科癌症患者中的表现。一项前瞻性观察性研究于 2014 年 1 月至 2016 年 12 月进行。连续纳入住院期间出现发热性疾病的儿童癌症患者。发热6小时内测定CRP、PCT、白细胞介素（IL）-6、IL-10、肿瘤坏死因子（TNF）-α、干扰素（IFN）-γ。总共纳入了 3118 例发热性疾病发作，其中 13.1% 的发作记录为血流感染 (BSI)，3.5% 诊断为感染性休克。 BSI患者的PCT、IL-6、IL-10和TNF-α水平显着高于其他类型发热患者，败血性休克的发生率也显着升高（11.2% vs. 2.3%，P < 0.001）。 IL-6 和 IL-10 在识别革兰氏阴性菌血症 (GNB) 和感染性休克患者方面分别比 CRP 和 PCT 表现出更好的性能。 CRP、PCT、IL-6 和 IL-10 的感染性休克预测受试者工作特征 (ROC) 曲线下面积 (AUC) 分别为 0.65、0.78、0.89 和 0.87。此外，IL-6 和 IL-10 的升高与 GNB 和感染性休克的发生密切相关。我们的结果表明，BSI，尤其是 GNB，是一种高危感染形式，导致感染性休克的高发生率。在识别高危发热性疾病患者方面，IL-6 和 IL-10 的表现优于 CRP 和 PCT。
The aim of this study is to systematically compare the performance of C-reactive protein (CRP), procalcitonin (PCT) and serum cytokines in identifying pediatric cancer patients with high-risk infection. A prospective observational study was performed from January 2014 through December 2016. Consecutive pediatric cancer patients who experienced febrile illness during hospitalization were enrolled. The CRP, PCT, interleukin (IL)-6, IL-10, tumor necrosis factor (TNF)-alpha and interferon (IFN)-gamma were determined within 6 h of fever onset. A total of 3118 episodes of febrile illness were included, with 13.1% episodes documented as bloodstream infection (BSI) and 3.5% diagnosed as septic shock. Patients with BSI presented much higher levels of PCT, IL-6, IL-10 and TNF-alpha than patients with other types of fever and have much higher incidence of septic shock (11.2% vs. 2.3%, P < 0.001). IL-6 and IL-10 showed better performance in identifying patients with gram-negative bacteremia (GNB) and septic shock than CRP and PCT, respectively. The area under the curve (AUCs) of receiver operating characteristic (ROC) curve for septic shock prediction were 0.65, 0.78, 0.89 and 0.87 for CRP, PCT, IL-6 and IL-10, respectively. Furthermore, elevation of IL-6 and IL-10 were strongly associated with the development of GNB and septic shock. Our results indicate that BSI, especially GNB, is a high-risk form of infection which results in high incidence of septic shock. IL-6 and IL-10 performance better than CRP and PCT in identifying patients with high-risk febrile illness.