Department of Pediatrics, Ankara Bilkent City Hospital, The University of Health Sciences, Ankara, Turkey.
Department of Medical Biochemistry, Dr.Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey.
Eur J Pediatr. 2024 May;183(5):2155-2162. doi: 10.1007/s00431-024-05478-7. Epub 2024 Feb 17.
The purpose of this study was to evaluate the association between interleukin-33 (IL-33) and its receptor Soluble Suppression of Tumorigenicity-2 (sST2) levels and bacterial infections during febrile neutropenia (FN) in pediatric patients with acute lymphoblastic leukemia (ALL). In this prospective, case-control study, participants were divided into 3 groups: ALL patients with FN (Group A), ALL patients without neutropenia and fever (Group B), and healthy children without infection and chronic disease (Group C). There were 30 cases in each group. Blood samples for IL-33 and sST2 have been drawn from patients in Group A before the initiation of treatment and on days 1 and 5 of treatment, and from patients in Groups B and C at initiation. At admission, mean IL-33 level (39.02 ± 26.40 ng/L) in Group B and mean sST2 level (185.3 ± 371.49 ng/ml) in Group A were significantly higher than the other groups (p = 0.038, p < 0.001, respectively). No difference was observed in the mean IL-33 and sST2 levels in the 5-day follow-up of patients in Group A (p = 0.82, p = 0.86, respectively). IL-33 and sST2 levels were not associated with fever duration, neutropenia duration or length of hospitalization. While C-reactive protein (CRP) was significantly higher in patients with positive blood culture (p = 0.021), IL-33 (p = 0.49) and sST2 (p = 0.21) levels were not associated with culture positivity. Conclusion: IL-33 and sST2 levels were not found valuable as diagnostic and prognostic markers to predict bacterial sepsis in patients with FN. What is Known: • Neutropenic patients are at high risk of serious bacterial and viral infections, but the admission symptom is often only fever. • Febrile neutropenia has a high mortality rate if not treated effectively. What is New: • Febrile neutropenia is not only caused by bacterial infections. Therefore, new biomarkers should be identified to prevent overuse of antibiotics. • Specific biomarkers are needed to diagnose bacterial sepsis in the early phase of febrile neutropenia.
本研究旨在评估白细胞介素-33（IL-33）及其受体可溶性抑制肿瘤生成素-2（sST2）水平与儿童急性淋巴细胞白血病（ALL）发热性中性粒细胞减少症（FN）期间细菌感染之间的关联。在这项前瞻性病例对照研究中，参与者分为 3 组：FN 的 ALL 患者（A 组）、无中性粒细胞减少和发热的 ALL 患者（B 组）和无感染和慢性疾病的健康儿童（C 组）。每组各有 30 例。在开始治疗前和治疗第 1 天和第 5 天，从 A 组患者中抽取血液样本以检测 IL-33 和 sST2，从 B 组和 C 组患者中在开始时抽取。入院时，B 组平均 IL-33 水平（39.02±26.40ng/L）和 A 组平均 sST2 水平（185.3±371.49ng/ml）明显高于其他组（p=0.038，p<0.001）。A 组患者在 5 天随访期间的平均 IL-33 和 sST2 水平无差异（p=0.82，p=0.86）。IL-33 和 sST2 水平与发热持续时间、中性粒细胞减少持续时间或住院时间无关。而 C 反应蛋白（CRP）在血培养阳性的患者中明显更高（p=0.021），IL-33（p=0.49）和 sST2（p=0.21）水平与培养阳性无关。结论：IL-33 和 sST2 水平作为预测 FN 患者细菌败血症的诊断和预后标志物没有价值。已知：中性粒细胞减少症患者发生严重细菌和病毒感染的风险很高，但入院症状通常只是发热。如果不进行有效治疗，发热性中性粒细胞减少症的死亡率很高。新内容：发热性中性粒细胞减少症不仅由细菌感染引起。因此，需要鉴定新的生物标志物以防止抗生素过度使用。需要特定的生物标志物来诊断发热性中性粒细胞减少症的早期细菌败血症。
