Postgraduate Program in Health Sciences, Federal University of Bahia School of Medicine, Salvador, Brazil.
Centro de Pesquisa Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil.
Cytokine. 2018 Jul;107:1-8. doi: 10.1016/j.cyto.2017.11.005. Epub 2017 Nov 20.
Community-acquired pneumonia (CAP) is the main cause of death in children under-5 years worldwide and Streptococcus pneumoniae is the most common bacterial agent. However, it is difficult to identify pneumococcal infection among children with CAP. We aimed to assess association between any cytokine/chemokine and pneumococcal infection in childhood CAP. Furthermore, we evaluated the diagnostic value of cytokine/chemokine for pneumococcal infection. This prospective study was conducted at an Emergency Room, in Salvador, Brazil. Children <5-years-old hospitalized with CAP in a 21-month period were evaluated. On admission, clinical and radiological data were collected along with biological samples to investigate 20 etiological agents and determine serum cytokines (interleukin (IL)-8, IL-6, IL-10, IL-1β, IL-12, TNF-α, IL-2, IL-4, IL-5, γ-interferon), and chemokines (CCL2, CCL5, CXCL9, CXCL10) concentration. From 166 patients with etiology detected, pneumococcal infection was detected in 38 (22.9%) cases among which the median IL-6(pg/ml) was 31.2 (IQR: 12.4-54.1). The other 128 cases had other causative agents detected (Haemophilus influenzae, Moraxella catarrhalis, atypical bacteria and viruses) with the median IL-6 concentration being 9.0 (IQR: 4.1-22.0; p < 0.001). The area under the ROC curve for IL-6 to predict pneumococcal CAP was 0.74 (95%CI: 0.65-0.83; p < 0.001). By multivariate analysis, with pneumococcal CAP as dependent variable, IL-6 was an independent predictor for pneumococcal infection (OR = 5.56; 95%CI: 2.42-12.75, cut-off point = 12.5 pg/ml; p = 0.0001). The negative predictive value of IL-6 under 12.5 pg/ml for pneumococcal infection was 90% (95%CI: 82-95%). Independently significant difference was not found for any other cytokines/chemokines. Serum IL-6 concentration on admission is independently associated with pneumococcal infection among children under-5 years hospitalized with CAP.
社区获得性肺炎（CAP）是全球 5 岁以下儿童死亡的主要原因，肺炎链球菌是最常见的细菌病原体。然而，很难确定 CAP 患儿的肺炎链球菌感染。我们旨在评估儿童 CAP 中任何细胞因子/趋化因子与肺炎链球菌感染之间的关联。此外，我们还评估了细胞因子/趋化因子对肺炎链球菌感染的诊断价值。这项前瞻性研究在巴西萨尔瓦多的一家急诊室进行。在 21 个月的时间里，对因 CAP 住院的 5 岁以下儿童进行了评估。入院时，收集了临床和影像学数据以及生物样本，以调查 20 种病因，并确定血清细胞因子（白细胞介素（IL）-8、IL-6、IL-10、IL-1β、IL-12、TNF-α、IL-2、IL-4、IL-5、γ-干扰素）和趋化因子（CCL2、CCL5、CXCL9、CXCL10）浓度。在检测到病因的 166 名患者中，38 名（22.9%）患儿检测到肺炎链球菌感染，其中 IL-6（pg/ml）中位数为 31.2（IQR：12.4-54.1）。另外 128 例患儿检测到其他病原体（流感嗜血杆菌、卡他莫拉菌、非典型细菌和病毒），IL-6 浓度中位数为 9.0（IQR：4.1-22.0；p<0.001）。IL-6 预测肺炎链球菌 CAP 的 ROC 曲线下面积为 0.74（95%CI：0.65-0.83；p<0.001）。通过多变量分析，以肺炎链球菌 CAP 为因变量，IL-6 是肺炎链球菌感染的独立预测因子（OR=5.56；95%CI：2.42-12.75，截断值=12.5 pg/ml；p=0.0001）。IL-6<12.5 pg/ml 时对肺炎链球菌感染的阴性预测值为 90%（95%CI：82-95%）。任何其他细胞因子/趋化因子均未发现独立显著差异。入院时血清 IL-6 浓度与 5 岁以下因 CAP 住院的儿童肺炎链球菌感染独立相关。
