Zhu Ruixin, Cao Lu, Wu Tianyi, Zhang Zizhen, Han Meilin, Liu Huaqing, Huang Saihu, Bai Zhenjiang, Wu Shuiyan
Pediatric Intensive Care Unit, Children's Hospital of Soochow University, Suzhou, China.
Soochow University, Suzhou, China.
Transl Pediatr. 2024 Jul 31;13(7):1169-1178. doi: 10.21037/tp-24-95. Epub 2024 Jul 25.
The current early warning model for organ damage in critically ill patients has certain limitations. Based on the pathological mechanism, the establishment of an early warning system for organ damage in critically ill children using cytokines profile has not been explored. The aim of this study is to explore the predicting value of cytokines in critically ill patients.
There were 200 critically pediatric patients and 49 general patients between August 22, 2018 and April 28, 2023 from Children's Hospital of Soochow University enrolled in this study. The clinical information was retrospectively collected and analyzed. The cytokine profiles of these patients were detected by flow cytometry. Receiver operating characteristic (ROC) curves were plotted to determine the association between the cytokines and organ injury.
There were no statistically significant differences in gender, age and underlying disease between critically ill patients and general patients. The interleukin (IL)-6 (P<0.001), IL-10 (P<0.001), IL-17A (P=0.001), tumor necrosis factor-α (TNF-α) (P=0.02) and interferon-γ (IFN-γ) (P=0.02) level in the critically patients were significantly higher than those in the general patients. The results showed that the incidence of acute gastrointestinal injury (AGI) and acute kidney injury (AKI) in critically ill patients was 39% and 23.5%, respectively. Moreover, there were 4% and 3.5% patients with the occurrence of cardiac arrest and acute live injury. The IFN-γ level was increased in these patients with acute liver injury compared to those without these organ injuries, but reduced in the patients with AGI compared to those without. The patients with AKI showed a significant increase in IL-10 in contrast to those without. The IL-2, IL-4, IL-6, IL-10 and IL-17A were higher in patients with acute liver failure (ALF), but TNF-α was reduced, compared to those without. The IL-2, IL-4, IL-6 and IL-10 were significantly increased in the patients with cardiac arrest compared to those without. When IL-10 was higher than 279.45 pg/mL, the sensitivity and specificity for predicting cardiac arrest were 0.875 and 0.927, respectively. While the sensitivity and specificity of IL-6 (more than 1,425.6 pg/mL) were 0.625 and 0.844, respectively. However, no synergistic effect of IL-6 and IL-10 was observed for predicting cardiac arrest. Additionally, the IL-17A (more than 21.6 pg/mL) was a good predictor for the incidence of ALF (sensitivity =0.714, specificity =0.876).
The cytokines profile was different between critically ill patients with organ injury and those without organ injury. The IL-6 and IL-10 levels were good predictors for cardiac arrest in critically ill patients. Additionally, higher IL-17A predicted the incidence of ALF of the critically ill patients.
目前危重症患者器官损伤的早期预警模型存在一定局限性。基于病理机制，利用细胞因子谱建立危重症儿童器官损伤早期预警系统的研究尚未开展。本研究旨在探讨细胞因子在危重症患者中的预测价值。
选取2018年8月22日至2023年4月28日苏州大学附属儿童医院的200例危重症儿科患者和49例普通患者纳入本研究。回顾性收集并分析临床资料。采用流式细胞术检测这些患者的细胞因子谱。绘制受试者工作特征（ROC）曲线以确定细胞因子与器官损伤之间的关联。
危重症患者与普通患者在性别、年龄和基础疾病方面无统计学显著差异。危重症患者的白细胞介素（IL）-6（P<0.001）、IL-10（P<0.001）、IL-17A（P=0.001）、肿瘤坏死因子-α（TNF-α）（P=0.02）和干扰素-γ（IFN-γ）（P=0.02）水平显著高于普通患者。结果显示，危重症患者急性胃肠损伤（AGI）和急性肾损伤（AKI）的发生率分别为39%和23.5%。此外，有4%和3.5%的患者发生心脏骤停和急性肝损伤。与未发生这些器官损伤的患者相比，急性肝损伤患者的IFN-γ水平升高，但与未发生AGI的患者相比降低。与未发生AKI的患者相比，发生AKI的患者IL-10显著升高。与未发生急性肝衰竭（ALF）的患者相比，发生ALF的患者IL-2、IL-4、IL-6、IL-10和IL-17A升高，但TNF-α降低。与未发生心脏骤停的患者相比，发生心脏骤停的患者IL-2、IL-4、IL-6和IL-10显著升高。当IL-10高于279.45 pg/mL时，预测心脏骤停的敏感性和特异性分别为0.875和0.927。而IL-6（高于1425.6 pg/mL）的敏感性和特异性分别为0.625和0.844。然而，未观察到IL-6和IL-10对预测心脏骤停的协同作用。此外，IL-17A（高于21.6 pg/mL）是ALF发生率的良好预测指标（敏感性=0.714，特异性=0.876）。
发生器官损伤的危重症患者与未发生器官损伤的危重症患者的细胞因子谱不同。IL-6和IL-10水平是危重症患者心脏骤停的良好预测指标。此外，较高的IL-17A可预测危重症患者ALF的发生率。
