Departamento de Pediatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
Departamento de Pediatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil; Universidade Paulista, UNIP, Sao Paulo, SP, Brazil.
Cytokine. 2023 Jan;161:156084. doi: 10.1016/j.cyto.2022.156084. Epub 2022 Nov 18.
The exacerbation of the inflammatory response caused by SARS-CoV-2 in adults promotes the production of soluble mediators that could act as diagnostic and prognostic biomarkers for COVID-19. Among the potential biomarkers, the soluble triggering receptor expressed on myeloid cell-1 (sTREM-1) has been described as a predictor of inflammation severity. The aim was to evaluate sTREM-1 and cytokine serum concentrations in pediatric patients during the acute and convalescent phases of COVID-19. This was a prospective study that included 53 children/adolescents with acute COVID-19 (Acute-CoV group); 54 who recovered from COVID-19 (Post-CoV group) and 54 controls (Control group). Preexisting chronic conditions were present in the three groups, which were defined as follows: immunological diseases, neurological disorders, and renal and hepatic failures. The three groups were matched by age, sex, and similar preexisting chronic conditions. No differences in sTREM-1 levels were detected among the groups or when the groups were separately analyzed by preexisting chronic conditions. However, sTREM-1 analysis in the seven multisystemic inflammatory syndrome children (MIS-C) within the Acute-Cov group showed that sTREM-1 concentrations were higher in MIS-C vs non-MIS-C acute patients. Then, the receiver operating curve analysis (ROC) performed with MIS-C acute patients revealed a significant AUC of 0.870, and the sTREM-1 cutoff value of > 5781 pg/mL yielded a sensitivity of 71.4 % and a specificity of 91.3 % for disease severity, and patients with sTREM-1 levels above this cutoff presented an elevated risk for MIS-C development in 22.85-fold (OR = 22.85 [95 % CI 1.64-317.5], p = 0.02). The cytokine analyses in the acute phase revealed that IL-6, IL-8, and IL-10 concentrations were elevated regardless of whether the patient developed MIS-C, and those levels decreased in the convalescent phase, even when compared with controls. Spearman correlation analysis generated positive indexes between sTREM-1 and IL-12 and TNF-α concentrations, only within the Acute-CoV group. Our findings revealed that sTREM-1 in pediatric patients has good predictive accuracy as an early screening tool for surveillance of MIS-C cases, even in patients with chronic underlying conditions.
严重急性呼吸综合征冠状病毒 2 引起的炎症反应加剧，促进了可溶性介质的产生，这些介质可作为 COVID-19 的诊断和预后生物标志物。在潜在的生物标志物中，可溶性髓系细胞触发受体 1（sTREM-1）已被描述为炎症严重程度的预测因子。目的是评估儿科 COVID-19 患者在急性和恢复期的 sTREM-1 和细胞因子血清浓度。这是一项前瞻性研究，纳入了 53 名急性 COVID-19 患儿/青少年（急性-CoV 组）；54 名从 COVID-19 中康复的患者（Post-CoV 组）和 54 名对照（对照组）。三组均存在先前存在的慢性疾病，定义如下：免疫性疾病、神经障碍、肾功能和肝功能衰竭。三组按年龄、性别和相似的先前存在的慢性疾病相匹配。各组之间或按先前存在的慢性疾病单独分析时，sTREM-1 水平无差异。然而，急性-CoV 组中的 7 名多系统炎症综合征患儿（MIS-C）的 sTREM-1 分析表明，MIS-C 患者的 sTREM-1 浓度高于非 MIS-C 急性患者。然后，对急性 MIS-C 患者进行的接收者操作特征曲线分析（ROC）显示，MIS-C 患者的 AUC 显著为 0.870，sTREM-1 截断值>5781pg/mL 时，对疾病严重程度的敏感性为 71.4%，特异性为 91.3%，sTREM-1 水平高于该截断值的患者发生 MIS-C 的风险增加 22.85 倍（OR=22.85[95%CI 1.64-317.5]，p=0.02）。急性期的细胞因子分析显示，IL-6、IL-8 和 IL-10 浓度升高，无论患者是否发生 MIS-C，在恢复期时这些水平均下降，甚至与对照组相比也是如此。Spearman 相关性分析在急性-CoV 组中产生了 sTREM-1 与 IL-12 和 TNF-α 浓度之间的正指数。我们的发现表明，sTREM-1 在儿科患者中具有良好的预测准确性，可作为早期筛查工具，用于监测 MIS-C 病例，即使在存在慢性潜在疾病的患者中也是如此。
