Diagnostic accuracy of G-CSF, IL-8, and IL-1ra in critically ill children with suspected infection.
OBJECTIVE
To elucidate the diagnostic accuracy of granulocyte colony-stimulating factor (G-CSF), interleukin-8 (IL-8), and interleukin-1 receptor antagonist (IL-1ra) in identifying patients with sepsis among critically ill pediatric patients with suspected infection.


METHODS
Nested case-control study in a multidisciplinary neonatal and pediatric intensive care unit (PICU) PATIENTS: PICU patients during a 12-month period with suspected infection, and plasma available from the time of clinical suspicion (254 episodes, 190 patients).


RESULTS
Plasma levels of G-CSF, IL-8, and IL-1ra. Episodes classified on the basis of clinical and bacteriological findings into: culture-confirmed sepsis, probable sepsis, localized infection, viral infection, and no infection. Plasma levels were significantly higher in episodes of culture-confirmed sepsis than in episodes with ruled-out infection. The area under the receiver operating characteristic curve was higher for IL-8 and G-CSF than for IL-1ra. Combining IL-8 and G-CSF improved the diagnostic performance, particularly as to the detection of Gram-negative sepsis. Sensitivity was low (<50%) in detecting Staphylococcus epidermidis bacteremia or localized infections.


CONCLUSIONS
In this heterogeneous population of critically ill children with suspected infection, a model combining plasma levels of IL-8 and G-CSF identified patients with sepsis. Negative results do not rule out S. epidermidis bacteremia or locally confined infectious processes. The model requires validation in an independent data-set.
Fischer
Joachim E
JE
Department of Pediatrics, University Children's Hospital, Steinwiesstrasse 75, 8032 Zurich, Switzerland. joachim.fischer@kispi.unizh.ch
Benn
Anne
A
Harbarth
Stephan
S
Nadal
David
D
Fanconi
Sergio
S
D019540:Area Under Curve; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000097:blood; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000097:blood; D006801:Humans; D007223:Infant; D007239:Infections / Q000097:blood / Q000175:diagnosis*; D053590:Interleukin 1 Receptor Antagonist Protein; D016209:Interleukin-8 / Q000097:blood; D016015:Logistic Models; D008297:Male; D012680:Sensitivity and Specificity; D012795:Sialoglycoproteins / Q000097:blood
C507763:IL1RN protein, human; D053590:Interleukin 1 Receptor Antagonist Protein; D016209:Interleukin-8; D012795:Sialoglycoproteins; D016179:Granulocyte Colony-Stimulating Factor; D016178:Granulocyte-Macrophage Colony-Stimulating Factor