title: Persistently low plasma thioredoxin is associated with meningococcal septic shock in children.
abstract: OBJECTIVE
  To compare plasma levels of thioredoxin (Trx), TNF-alpha and IL-1 beta in children during the acute phase of meningococcal septic shock (MSS) and in convalescence.
  
  
  METHODS
  Retrospective, observational study in the paediatric intensive care unit of a postgraduate teaching hospital.
  
  
  METHODS
  Thirty-five children requiring intensive care for meningococcal sepsis; paired convalescent samples from 30 survivors (median interval between samples 62 days); 25 healthy control children.
  
  
  RESULTS
  Plasma Trx levels were significantly lower in the children with MSS, both during the acute illness (5.5 ng/ml, IQR 1.4-11.4) and in convalescence (2.5 ng/ml, IQR 0.4-6.9) than controls (18.8 ng/ml, IQR 7.9-25.0). Levels of IL-1 beta and TNF-alpha were higher in patients with acute MSS (30.3 pg/ml, IQR 3.6-63.6, and 145.9 pg/ml, IQR 31.8-278.1 respectively) than controls (3.7 pg/ml, IQR 0-36.9, and 23.8 pg/ml, IQR 0-124.3, respectively). Levels fell in convalescence (3.7 pg/ml, IQR 0-25.5, 3.7 pg/ml, IQR 0-304.8, respectively). Plasma Trx was higher in non-survivors, albeit a small group (n=5), than in survivors (n=30). Trx, IL-1 beta, and TNF-alpha levels were not correlated with predicted mortality as assessed by the paediatric risk of mortality (PRISM) score.
  
  
  CONCLUSIONS
  Children with MSS exhibit persistently low plasma levels of Trx during acute illness and in convalescence.
authors.affiliation: Unit of Critical Care, National Heart and Lung Institute Division, Imperial College Faculty of Medicine, Royal Brompton Hospital, SW3 6 lY, London, UK.
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Callister
authors.forename: Anne
authors.initials: A
authors.lastname: Burke-Gaffney
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Quinlan
authors.forename: Helen
authors.initials: H
authors.lastname: Betts
authors.forename: Simon
authors.initials: S
authors.lastname: Nadel
authors.forename: Timothy W
authors.initials: TW
authors.lastname: Evans
mesh_terms: D016022:Case-Control Studies; D002675:Child, Preschool; D006801:Humans; D015278:Intensive Care Units, Pediatric; D053583:Interleukin-1beta / Q000097:blood; D008589:Meningococcal Infections / Q000097:blood* / Q000401:mortality; D012189:Retrospective Studies; D012772:Shock, Septic / Q000097:blood* / Q000401:mortality; D016019:Survival Analysis; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood* / Q000401:mortality; D013879:Thioredoxins / Q000097:blood*; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
chemical_list: D053583:Interleukin-1beta; D014409:Tumor Necrosis Factor-alpha; D013879:Thioredoxins