Table_1_Evaluating IL-6 and IL-10 as rapid diagnostic tools for Gram-negative bacteria and as disease severity predictors in pediatric sepsis patients in the intensive care unit.docx

BackgroundTo explore the diagnostic performance of interleukin (IL)-6 and IL-10 in discriminating Gram bacteria types and predicting disease severity in intensive care unit (ICU)-hospitalized pediatric sepsis patients.
MethodWe retrospectively collected Th1/Th2 cytokine profiles of 146 microbiologically documented sepsis patients. Patients were categorized into Gram-positive (G+) or Gram-negative (G-) sepsis groups, and cytokine levels were compared. Subgroup analysis was designed to eliminate the influence of other inflammatory responses on cytokine levels.
ResultsAfter propensity score matching, 78 patients were matched and categorized according to Gram bacteria types. Compared with G+ sepsis, IL-6 and IL-10 were significantly elevated in G- sepsis (p < 0.05). Spearman test proved the linear correlation between IL-6 and IL-10 (r = 0.654, p < 0.001), and their combination indicators (ratio and differences) were effective in identifying G- sepsis. In the subgroup analysis, such cytokine elevation was significant regardless of primary infection site. However, for patients with progressively deteriorating organ function [new or progressive multiple organ dysfunction syndrome (NPMODS)], differences in IL-6 and IL-10 levels were less significant between G+ and G- sepsis. In the receiver operating characteristic (ROC) curves of the G- sepsis group, the area under the curve (AUC) value for IL-6 and IL-10 was 0.679 (95% CI 0.561–0.798) and 0.637 (95% CI 0.512–0.762), respectively. The optimal cutoff value for diagnosing G- sepsis was 76.77 pg/ml and 18.90 pg/ml, respectively. While for the NPMODS group, the AUC for IL-6 and IL-10 was 0.834 (95% CI 0.766–0.902) and 0.781 (95% CI 0.701–0.860), respectively.
ConclusionIL-6 and IL-10 are comparably effective in discriminating G+/G- sepsis in pediatric intensive care unit (PICU) patients. The deteriorated organ function observed in ICU patients reveals that complex inflammatory responses might have contributed to the cytokine pattern observed in severe sepsis patients, therefore confounding the discriminating efficacy of Th1/Th2 cytokines in predicting Gram bacteria types.

研究背景：本研究旨在探讨白细胞介素-6（interleukin-6, IL-6）与白细胞介素-10（interleukin-10, IL-10）在鉴别革兰氏菌类型及预测住院重症监护病房（intensive care unit, ICU）儿童脓毒症患者病情严重程度中的诊断效能。
研究方法：本研究回顾性收集了146例经微生物学证实的脓毒症患者的Th1/Th2细胞因子谱。将患者分为革兰氏阳性（G+）脓毒症组与革兰氏阴性（G-）脓毒症组，对比两组细胞因子水平。本研究设计亚组分析以排除其他炎症反应对细胞因子水平的干扰。
研究结果：经倾向得分匹配后，共纳入78例按革兰氏菌类型分组的匹配患者。与G+脓毒症组相比，G-脓毒症组患者的IL-6与IL-10水平显著升高（p < 0.05）。斯皮尔曼相关性检验证实IL-6与IL-10之间存在线性相关（r=0.654，p < 0.001），二者的联合指标（比值与差值）可有效鉴别G-脓毒症。亚组分析显示，无论原发感染部位如何，细胞因子水平升高的差异均具有统计学意义。但对于器官功能进行性恶化的患者[新发或进展性多器官功能障碍综合征（new or progressive multiple organ dysfunction syndrome, NPMODS）]，G+与G-脓毒症组间IL-6、IL-10水平的差异则不再显著。在G-脓毒症组的受试者工作特征（receiver operating characteristic, ROC）曲线中，IL-6与IL-10的曲线下面积（area under the curve, AUC）分别为0.679（95%置信区间0.561~0.798）与0.637（95%置信区间0.512~0.762），二者诊断G-脓毒症的最佳临界值分别为76.77 pg/ml与18.90 pg/ml。而在NPMODS亚组中，IL-6与IL-10的AUC分别为0.834（95%置信区间0.766~0.902）与0.781（95%置信区间0.701~0.860）。
研究结论：IL-6与IL-10在儿童重症监护病房（pediatric intensive care unit, PICU）脓毒症患者中鉴别G+/G-脓毒症的效能相当。ICU患者出现的器官功能恶化提示，复杂的炎症反应可能参与了重症脓毒症患者的细胞因子谱改变，从而干扰了Th1/Th2细胞因子预测革兰氏菌类型的鉴别效能。