Wang Qi, Wang Chi, Yang Ming, Li Xinjun, Cui Jiayue, Wang Chengbin
Department of Clinical Laboratory Medicine, Chinese PLA General Hospital & Medical School of Chinese PLA, Beijing 100853, China; Department of Orthopedics, Chinese PLA General Hospital & Medical School of Chinese PLA, Beijing 100853, China.
Department of Clinical Laboratory Medicine, Chinese PLA General Hospital & Medical School of Chinese PLA, Beijing 100853, China.
Cytokine. 2020 Apr 1;130:155081. doi: 10.1016/j.cyto.2020.155081.
The role of serum cytokines/chemokines in differential diagnosis between fungal infections and bacterial infections have not been fully understood. This study aims to measure the serum levels of cytokines/chemokines in cases of candidemia and to compare them with those observed in cases of bacteremia.
Patients with febrile episodes and were identified as bloodstream infections through blood culture were enrolled, while healthy people were included as control group. Fourteen serum cytokine and chemokine levels were detected with multiplex platform. ROC analysis was performed and an area under the curve (AUC), sensitivity and specificity values were calculated to determine the efficacy of various cytokines and chemokines for candidemia and bacteremia. Binary logistic regression was performed to further explore the combination mode of cytokines and chemokines, which could increase the diagnostic efficiency.
We included 40 patients with an episode of microbiologically proven fungal infection, 175 patients with bacteremia (85 with Gram-positive bacteremia and 90 with Gram-negative bacteremia) and another 30 healthy controls. Routine laboratory parameters including CRP and PCT were not statistically significant between candidemia group and bacteremia group (both gram-positive and gram-negative). There were significantly higher levels of IFN-γ, TNF-α, IL-10 and lower levels of IL-3, IL-4 in candidemia group, compared with gram-positive and gram-negative bacteremia groups. G-CSF was significantly lower and MIP-1β was higher in candidemia group, when compared with gram-negative bacteremia group. While IL-6, IL-8 and IL-17 were all significantly higher in candidemia group, when compared with gram-positive bacteremia group. Combination of IFN-γ and IL-17 could improve the diagnostic efficiency between candidemia and gram-positive bacteremia, with the AUROC of 0.873 (95% CI: 0.767-0.929). While combination of G-CSF and MIP-1β improved the diagnostic efficiency between candidemia and gram-negative bacteremia, with the AUROC of 0.896 (95% CI: 0.792-0.939).
Our study demonstrates that serum cytokines and chemokines including IFN-γ, MIP-1β, IL-17 and G-CSF could be considered as diagnostic markers to distinguish between candidemia and bacteremia. Combination of these biomarkers might improve the diagnostic efficiency of candidemia when compared with bacteremia.
血清细胞因子/趋化因子在真菌感染与细菌感染鉴别诊断中的作用尚未完全明确。本研究旨在测定念珠菌血症患者血清细胞因子/趋化因子水平，并与菌血症患者的水平进行比较。
纳入有发热症状且经血培养确诊为血流感染的患者，同时纳入健康人作为对照组。采用多重检测平台检测14种血清细胞因子和趋化因子水平。进行ROC分析，计算曲线下面积（AUC）、敏感性和特异性值，以确定各种细胞因子和趋化因子对念珠菌血症和菌血症的诊断效能。进行二元逻辑回归分析，进一步探索可提高诊断效率的细胞因子和趋化因子组合模式。
我们纳入了40例经微生物学证实的真菌感染患者、175例菌血症患者（85例革兰氏阳性菌血症和90例革兰氏阴性菌血症）以及另外30例健康对照。念珠菌血症组与菌血症组（革兰氏阳性和革兰氏阴性）之间的常规实验室参数包括CRP和PCT无统计学差异。与革兰氏阳性和革兰氏阴性菌血症组相比，念珠菌血症组IFN-γ、TNF-α、IL-10水平显著升高，IL-3、IL-4水平降低。与革兰氏阴性菌血症组相比，念珠菌血症组G-CSF显著降低，MIP-1β升高。与革兰氏阳性菌血症组相比，念珠菌血症组IL-6、IL-8和IL-17均显著升高。IFN-γ和IL-17联合可提高念珠菌血症与革兰氏阳性菌血症之间的诊断效率，AUROC为0.873（95%CI：0.767-0.929）。G-CSF和MIP-1β联合可提高念珠菌血症与革兰氏阴性菌血症之间的诊断效率，AUROC为0.896（95%CI：0.792-0.939）。
我们的研究表明，包括IFN-γ、MIP-1β、IL-17和G-CSF在内的血清细胞因子和趋化因子可作为区分念珠菌血症和菌血症的诊断标志物。与菌血症相比，这些生物标志物的联合应用可能提高念珠菌血症的诊断效率。
