Int J Med Sci 2022; 19(4):753-761. doi:10.7150/ijms.69859 This issue
1. Lithuanian University of Health Sciences, Medical Academy, Department of Pediatrics, 50161 Kaunas, Lithuania.
2. Lithuanian University of Health Sciences, Medical Academy, Department of Laboratory Medicine, 50161 Kaunas, Lithuania.
3. Laboratory of Preclinical Drug Investigation, Institute of Cardiology, Lithuanian University of Health Sciences, 50161 Kaunas, Lithuania.
*Both authors contributed equally to this work.
Background and objectives: While most feverish children have self-limiting diseases, 5-10% develop a serious and potentially life-threatening bacterial infection (BI). Due to potential risk, prompt recognition of BI and sepsis in the pediatric emergency department (PED) remains a clinical priority. The aim of the study was to evaluate the role of certain cytokines and chemokines separately and in combination with routine blood tests in early BI and sepsis diagnostics at PED. Materials and methods: We prospectively studied children younger than 5 presenting to the PED with fever lasting for under 12 hours with high risk for serious illness. Clinical data, routine blood analysis, and inflammatory cytokine and chemokine panels were evaluated for their diagnostic abilities. Two separate analyses were carried out on the patients' data: one contrasting BI and viral infection (VI) groups, the other comparing septic and non-septic patients. Results: The sample comprised 70 patients (40% with BI). IL-2 was found to be the most specific biomarker to identify BI with specificity of 100%. The best discriminative ability was demonstrated by combining IL-2, IL-6, CRP, WBC, and neutrophil count: AUC 0.942 (95% Cl 0.859-0.984). IL-10 exhibited a greater AUC (0.837. 95% CI: 0.730-0.915 p<0.05) than CRP (0.807. 95% CI: 0.695-0.895 p<0.05) when predicting sepsis and showed high specificity (98%) and moderate sensitivity (75%). Conclusions: IL-6 and IL-2 could increase the diagnostic ability of routine blood tests for predicting BI, as IL-10 raises specificity for recognizing sepsis in the early hours of disease onset.
Keywords: blood biomarkers, pediatric emergency department, sepsis, bacterial infection, cytokine, chemokine