Inflammatory cytokine measurement quickly discriminates gram-negative from gram-positive bacteremia in pediatric hematol
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PEDIATRIC ORIGINAL
Xiao-Jun Xu Yong-Min Tang Chan Liao Hua Song Shi-Long Yang Wei-Qun Xu Shu-Wen Shi Ning Zhao
Inflammatory cytokine measurement quickly discriminates gram-negative from gram-positive bacteremia in pediatric hematology/oncology patients with septic shock
Received: 3 August 2012 Accepted: 28 October 2012
Abstract Purpose: We performed a prospective study to evaluate the ability of inflammatory cytokines in discriminating gram-negative from gram-positive bacteremia in septic shock. Methods: During the study period, the serum inflammatory cytokine levels were measured at the onset of septic shock by flow cytometry in pediatric hematology/ oncology patients with septic shock. Results: One hundred episodes of septic shock were enrolled. Of 97 episodes of monomicrobial infection, 73.2 % were caused by gram-negative bacteremia and 26.8 % by grampositive bacteremia. Interleukin (IL)-6, IL-10, and tumor necrosis factor (TNF)-a were closely related to the pediatric index of mortality 2 (PIM2) score and mortality. However, although the PIM2 score and mortality were comparable, the IL-6, IL-10, and TNF-a levels were significantly higher in patients with gram-negative bacteremia (GNB) than those with gram-positive bacteremia (median levels, pg/mL: IL-6: 784.1 vs. 254.4, P = 0.001; IL-10:
Ó Springer-Verlag Berlin Heidelberg and ESICM 2012
X.-J. Xu Y.-M. Tang ()) C. Liao H. Song S.-L. Yang W.-Q. Xu S.-W. Shi N. Zhao Division of Hematology-Oncology, Children’s Hospital of Zhejiang University School of Medicine, Hangzhou 310003, People’s Republic of China e-mail: [email protected] Tel.: ?86-571-88873450 Fax: ?86-571-87033296 X.-J. Xu Y.-M. Tang N. Zhao Key Laboratory of Reproductive Genetics, Zhejiang University, Ministry of Education, Hangzhou 310003, People’s Republic of China
Introduction Hematological disorders and presence of shock are associated with high mortality in pediatric intensive care units (PICU) [1, 2]. Septic shock in patients with cancer, especially during the neutropenic stage, can be rapidly fatal if it is not appropriately treated. The delay of
192.2 vs. 19.7, P \ 0.001; TNF-a: 4.2 vs. 2.0, P \ 0.001). Of the three cytokines, IL-10 was the most useful biomarker for GNB prediction in the derivation cohort and a cutoff value of 50 pg/mL showed a sensitivity of 70.8 % and a specificity of 80.0 %, with a positive predictive value of 89.5 %. When this cutoff value was applied to the validation cohort, the sensitivity, specificity, and positive predictive value were 80.9, 75.0, and 90.5 %, respectively. Conclusions: Flow cytometry-based inflammatory cytokine measurement is a helpful adjuvant approach for early and quick discrimination of gram-negative from gram-positive bacteremia in pediatric hematology/ oncology patients with septic shock which might be useful for evaluating the severity of shock and the selection and/or timely withdrawal or switch of antibiotics. Keywords Cytokine Septic shock Gram-negative bacteremia Interleukin-10 Flow cytometry
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