Relation between cytokines and routine laboratory data in children with septic shock and purpura.

OBJECTIVE

To establish the relation between routine laboratory data (lactate, fibrinogen, CRP) and cytokines (TNF,IL-1 and -6) and to estimate their prognostic value in pediatric patients with severe infectious purpura on admission.

DESIGN

Prospective study.

SETTING

Pediatric intensive care unit (PICU).

PATIENTS

17 children aged 5-172 months (median 46) were hospitalized in our PICU in 1989-90 with severe infectious purpura. Neisseria meningitidis was isolated in 15 children and Haemophilus influenzae in two. The patients were divided into 3 groups: non-shock, shock and severe shock leading to death. Shock was defined by standard criteria.

MEASUREMENTS

Arterial blood was sampled for lactate, CRP, fibrinogen, TNF, and IL-1 and -6 on admission. The PRISM (pediatric risk of morality)-score was recorded.

METHODS

Statistical analysis was performed with the Student's t-test using the logarithmic values of the cytokine concentration, and Spearman correlation analysis.

RESULTS

According to the shock criteria, 9 patients were in shock of whom 4 did not survive. Significant differences existed between the 3 groups concerning lactate, TNF, and IL-6. Fibrinogen, CRP, IL-1, and PRISM-score discriminated only between survivors and non-survivors. A highly significant correlation existed between cytokines, the PRISM-score and lactate (TNF: r = 0.69, IL-1: r = 0.56, IL-6: r = 0.65, PRISM: r = 0.65). A significant inverse correlation existed between cytokines and CRP (TNF: r = -0.55, IL-1: r = -0.64, and IL-6: r = -0.56), and IL-6 and fibrinogen (r = -0.65).

CONCLUSION

These results show a significant correlation between cytokines and lactate, and lactate, TNF and IL-6 are closely associated with the severity of septic shock with purpura in children.