Interleukin-27 as a candidate diagnostic biomarker for bacterial infection in immunocompromised pediatric patients.
Interleukin-27 as a candidate diagnostic biomarker for bacterial infection in immunocompromised pediatric patients.
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DOI：
10.1371/journal.pone.0207620
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发表时间：
2018
期刊：
影响因子：
3.7
通讯作者：
Wong HR
中科院分区：
文献类型：
--
作者：
Jacobs L;Berrens Z;Stenson EK;Zackoff M;Danziger-Isakov L;Lahni P;Wong HR
免疫功能低下的儿科患者人数不断增加，特别容易受到细菌感染，因此需要及时识别和治疗。本研究评估了白细胞介素 27 (IL-27) 和降钙素原 (PCT) 作为免疫功能低下儿科受试者细菌感染生物标志物的效用。这是一项单中心前瞻性队列研究，于 2016 年 7 月至 2017 年 9 月期间进行，受试者来自辛辛那提儿童医院医疗中心 (CCHMC)（一家大型三级护理儿童医院）的住院部。如果患者符合免疫功能低下的定义并且临床怀疑感染（通过在入院期间的任何时间点采集血培养来定义），则将其纳入其中。主要分析使用 PCT 作为比较，评估了 IL-27 诊断免疫功能低下儿科患者细菌感染的准确性。招募了 293 名患者，代表 400 例疑似细菌感染病例。中位年龄为 7.8 岁（IQR 3.1-13.8 岁）。 53% (n = 213) 的人口进行了原发性肿瘤诊断，24% (n = 95) 接受了骨髓移植，21% (n = 85) 接受了实体器官移植。总体感染率为 37%，其中 70% 的患者具有某种形式的培养阳性。 28 天死亡率为 5%，60 天死亡率为 9%，87% 的患者存活至出院。诊断细菌感染的 ROC 曲线的 AUC 对于 IL-27 为 0.62（0.5-0.68），对于 PCT 为 0.65（0.6-0.73）。使用之前确定的 5.0 ng/mL 临界值，IL-27 诊断细菌感染的特异性达到 94%，阴性预测值为 64%。尽管之前的工作证明 IL-27 和 PCT 可能是免疫功能低下儿科患者细菌感染的生物标志物，但我们无法验证这些发现。这说明了在这一弱势群体中开发可靠的细菌感染生物标志物所面临的挑战。
Immunocompromised pediatric patients constitute a growing population that is particularly vulnerable to bacterial infection, necessitating prompt recognition and treatment. This study assessed the utility of interleukin-27 (IL-27) and procalcitonin (PCT) as biomarkers of bacterial infection among immunocompromised pediatric subjects. This is a single-center prospective cohort study conducted from July 2016 through September 2017, drawing subjects from the inpatient units at Cincinnati Children’s Hospital Medical Center (CCHMC), a large, tertiary care children’s hospital. Patients were included if they fit the definition of immunocompromised and were under clinical suspicion for infection, defined by the acquisition of a blood culture at any point during the admission. The primary analysis assessed the accuracy of IL-27 to diagnose bacterial infection in immunocompromised pediatric patients, using PCT as a comparator. 293 patients were recruited, representing 400 episodes of suspected bacterial infection. The median age was 7.8 years (IQR 3.1–13.8 years). Fifty-three percent (n = 213) of the population had a primary oncologic diagnosis, 24% (n = 95) had received a bone marrow transplant, and 21% (n = 85) had received a solid organ transplant. The overall infection rate was 37%, with 70% of those patients having some form of culture positivity. Twenty-eight-day mortality was 5%, 60-day mortality was 9%, with 87% of patients surviving to hospital discharge. The AUC’s of the ROC curve to diagnose bacterial infection were 0.62 (0.5–0.68) for IL-27 and 0.65 (0.6–0.73) for PCT. Using the previously determined cutoff of 5.0 ng/mL, the specificity of IL-27 to diagnose bacterial infection reached 94%, with a negative predictive value of 64%. Despite prior work demonstrating IL-27 and PCT as possible biomarkers of bacterial infection in immunocompromised pediatric patients, we were unable to validate these findings. This illustrates the challenges associated with developing reliable biomarkers of bacterial infection in this vulnerable population.
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DOI：
10.1056/nejmoa1611391
发表时间：
2017-01-05
期刊：
The New England journal of medicine
影响因子：
--
作者：
Kaddourah A;Basu RK;Bagshaw SM;Goldstein SL;AWARE Investigators
通讯作者：
AWARE Investigators
DOI：
10.1097/shk.0b013e3182a67632
发表时间：
2013-11
期刊：
Shock (Augusta, Ga.)
影响因子：
--
作者：
Wong HR;Lindsell CJ;Lahni P;Hart KW;Gibot S
通讯作者：
Gibot S
影响因子：
32.4
作者：
Pflanz, S;Timans, JC;Kastelein, RA
通讯作者：
Kastelein, RA
影响因子：
8.8
作者：
Zinter, Matt S.;Dvorak, Christopher C.;Sapru, Anil
通讯作者：
Sapru, Anil
影响因子：
1.8
作者：
Meyer, Claudius U;Birkholz, Julia;Knuf, Markus
通讯作者：
Knuf, Markus