Postgraduation Program in Health Sciences, Federal University of Bahia School of Medicine, Salvador, Brazil; Health Sciences Center, Federal University of Recôncavo da Bahia, Santo Antonio de Jesus, Brazil.
Centro de Pesquisa Gonçalo Muniz, Fundação Oswaldo Cruz, Salvador, Brazil.
Cytokine. 2020 Nov;135:155191. doi: 10.1016/j.cyto.2020.155191. Epub 2020 Jul 23.
Community-acquired pneumonia (CAP) diagnosis remains a challenge in paediatrics. Chest radiography is considered gold standard for definition of pneumonia, however no previous study assessed the relationship between immune response and radiographic-confirmed-pneumonia. We assessed association between cytokines/chemokines levels and radiographic abnormalities in children with CAP. Children < 5-years-old hospitalized with CAP were investigated in a prospective study at the Federal University of Bahia Hospital, Brazil. On admission, clinical data and biological samples were collected to investigate 20 aetiological agents and determine serum cytokines/chemokines levels; chest radiographs were performed. Among 158 patients, radiographic diagnosis of pneumonia was confirmed in 126(79.7%) and 17(10.8%) had pleural effusion. Viral, bacterial and pneumococcal infection were detected in 80(50.6%), 78(49.4%) and 37(23.4%) cases. By comparing the median concentrations of serum cytokines/chemokines between children with or without pleural effusion, interleukin(IL)-6 was higher (26.6[18.6-103.7] vs 3.0[0.0-19.8]; p < 0.001) among those with pleural effusion; and between children with or without radiographic-confirmed-pneumonia, IL-6 was higher in the first subgroup (4.5[0.0-23.4] vs 0.0[0.0-3.6]; p = 0.02) after having excluded cases with pleural effusion. Stratified analyses according to aetiology showed IL-6 increase in the radiographic-confirmed-pneumonia subgroup inside the pneumococcal infection (28.2[5.9-64.1] vs 0.0[0.0-0.0]; p = 0.03) subgroup. By multivariable analysis, with IL-6 as dependent variable, pneumococcal infection and pleural effusion showed independent association with IL-6 elevation [respective OR: 5.071 (95%CI = 2.226-11.548; p < 0.001) and 13.604 (95%CI = 3.463-53.449; p = 0.0001)]. Considering the cases without pleural effusion, the area under the curve of IL-6 to predict pneumococcal infection was 0.76 (95%CI = 0.66-0.86; p < 0.001). IL-6 increase is a potential biomarker of pneumococcal infection among children with CAP without pleural effusion upon admission.
社区获得性肺炎（CAP）的诊断仍然是儿科的一个挑战。胸部 X 线摄影被认为是肺炎定义的金标准，但以前没有研究评估免疫反应与放射学确诊肺炎之间的关系。我们评估了 CAP 患儿细胞因子/趋化因子水平与放射异常之间的关系。在巴西联邦大学医院进行的一项前瞻性研究中，对<5 岁因 CAP 住院的儿童进行了调查。入院时，收集临床数据和生物样本以调查 20 种病因，并确定血清细胞因子/趋化因子水平；进行了胸部 X 光检查。在 158 名患者中，126 名（79.7%）的放射学诊断为肺炎，17 名（10.8%）有胸腔积液。在 80 名（50.6%）、78 名（49.4%）和 37 名（23.4%）患者中检测到病毒、细菌和肺炎球菌感染。通过比较有或无胸腔积液的儿童血清细胞因子/趋化因子的中位数浓度，胸腔积液组的白细胞介素（IL）-6 更高（26.6[18.6-103.7] vs 3.0[0.0-19.8]；p<0.001）；在有或无放射学确诊肺炎的儿童中，胸腔积液组的 IL-6 更高（4.5[0.0-23.4] vs 0.0[0.0-3.6]；p=0.02）。根据病因进行分层分析显示，肺炎球菌感染组的放射学确诊肺炎亚组中 IL-6 增加（28.2[5.9-64.1] vs 0.0[0.0-0.0]；p=0.03）。多变量分析显示，IL-6 为因变量，肺炎球菌感染和胸腔积液与 IL-6 升高呈独立相关[各自的比值比：5.071（95%可信区间：2.226-11.548；p<0.001）和 13.604（95%可信区间：3.463-53.449；p=0.0001）]。考虑到没有胸腔积液的病例，IL-6 预测肺炎球菌感染的曲线下面积为 0.76（95%可信区间：0.66-0.86；p<0.001）。入院时无胸腔积液的 CAP 患儿 IL-6 升高是肺炎球菌感染的潜在生物标志物。
