Zhou Y Q, Zhao N, Xia T, Tang Y M
Department of Hematology/Oncology, Children's Hospital of Zhejiang University School of Medicine, Hangzhou 310003, China.
Hematology/Oncology Lab, Children's Hospital of Zhejiang University School of Medicine, Hangzhou 310003, China.
Zhonghua Er Ke Za Zhi. 2019 Mar 2;57(3):200-205. doi: 10.3760/cma.j.issn.0578-1310.2019.03.008.
To explore the value of cytokines and procalcitonin (PCT) in predicting the potential pathogen and the severity of infection in children with hematological malignancies. This was a prospective cohort study. A total of 1 543 children (3 912 episodes) with hematological malignancies admitted to the Department of Hematology/Oncology in Children's Hospital of Zhejiang University School of Medicine from November 2010 to June 2018 were prospectively enrolled in this study. According to the pathogen, the patients were divided into sepsis group with positive blood culture (380 patients/608 episodes), sepsis group with negative blood culture (539/1 484), non-septic infection group (549/1 709), viral infection group (18/21) and fungal infection group (57/90). The patients were also divided into two groups in either shock group (171/187) or non-shock group (1 372/3 725). Meanwhile, 89 children (112 episodes) with matched hematological malignancies without fever were enrolled as the control group. The levels of PCT and cytokines were measured for detecting the potential relationship between these markers and infection severity. Mann-Whitney test or Kruskal-Wallis test was used to compare the differences between groups. The Receiver Operator Characteristic curve analysis was used to explore the predictive value. (1) There were significantly higher levels of interleukin (IL) 6 (=210.002, <0.01), IL-10 (=223.045, <0.01), and PCT (=76.799, <0.01) in the infection group, with area under curre (AUC) of 0.67 (95 0.640.69), 0.69 (95 0.660.71) and 0.59 (95 0.560.61), respectively. (2) Among the patients in the shock group, IL-6 (11.460, <0.01), IL-10 (14.242, <0.01) and PCT (10.813, <0.01) were significantly higher than those in the non-shock group, with the AUC of 0.75 (95 0.700.79), 0.81 (95 0.770.84) and 0.73 (95 0.690.77), respectively. (3) In patients with septic shock, the incidence of Gram negative bacteria (GNB) infection (60 episodes) was significantly higher than Gram positive bacteria (GPB) infection (22 episodes) (χ(2)=29.665, <0.01). The AUC of IL-6, IL-10 and PCT for predicting GNB infection were 0.75 (95 0.720.78), 0.82 (95 0.790.85) and 0.67 (95 0.630.70), respectively. (4) The predictive power of IL-6, IL-10 and PCT combination (AUC=0.994) was superior to IL-10 alone (AUC=0.810) in predicting septic shock (10.211, <0.01). IL-6 and IL-10 are better predictors of GNB infection than PCT in hematology-oncology children. Furthermore, the combination of these two cytokines and PCT is more valuable in predicting the severity of infection.
探讨细胞因子和降钙素原（PCT）在预测血液系统恶性肿瘤患儿潜在病原体及感染严重程度方面的价值。这是一项前瞻性队列研究。2010年11月至2018年6月期间，浙江大学医学院附属儿童医院血液科/肿瘤科收治的1543例血液系统恶性肿瘤患儿（共3912次发病）被前瞻性纳入本研究。根据病原体，将患者分为血培养阳性的脓毒症组（380例患者/608次发病）、血培养阴性的脓毒症组（539/1484）、非脓毒症感染组（549/1709）、病毒感染组（18/21）和真菌感染组（57/90）。患者还被分为休克组（171/187）和非休克组（1372/3725）。同时，选取89例（112次发病）匹配的无发热血液系统恶性肿瘤患儿作为对照组。检测PCT和细胞因子水平，以探究这些标志物与感染严重程度之间的潜在关系。采用Mann-Whitney检验或Kruskal-Wallis检验比较组间差异。使用受试者工作特征曲线分析来探究预测价值。（1）感染组白细胞介素（IL）-6（Z = 210.002，P < 0.01）、IL-10（Z = 223.045，P < 0.01）和PCT（Z = 76.799，P < 0.01）水平显著更高，曲线下面积（AUC）分别为0.67（95%CI 0.64 - 0.69）、0.69（95%CI 0.66 - 0.71）和0.59（95%CI 0.56 - 0.61）。（2）休克组患者的IL-6（Z = 11.460，P < 0.01）、IL-10（Z = 14.242，P < 0.01）和PCT（Z = 10.813，P < 0.01）显著高于非休克组，AUC分别为0.75（95%CI 0.70 - 0.79）、0.81（95%CI 0.77 - 0.84）和0.73（95%CI 0.69 - 0.77）。（3）在感染性休克患者中，革兰阴性菌（GNB）感染（60次发病）的发生率显著高于革兰阳性菌（GPB）感染（22次发病）（χ² = 29.
