title: Exploring beyond viral load testing for EBV lymphoproliferation: role of serum IL-6 and IgE assays as adjunctive tests.
abstract: We examined serum IL-6 and IgE assays as adjuncts to VL monitoring for PTLD. Paediatric solid organ transplant recipients were followed with VL monitoring. VL, IL-6, and IgE assays were compared between PTLD cases and non-cases at <3, 3-6 and >6 months after transplantation. Median IL-6 levels in PTLD cases were 15.5 (2.0-87.1) and 23.3 (2.1-276) pg/mL compared with 3.25 (0.92-114) and 3.5 (0.75-199.25) pg/mL in non-cases at 3-6 and >6 months, respectively (p = 0.006 and p = 0.005). At >6 months, IL-6 levels correlated with VL and PTLD occurrence (Spearman's coefficients = 0.40; p = 0.001 and 0.32; p = 0.003) in univariate analyses. No benefit was derived from performance of IgE levels. The sensitivity and specificity of high VL as a test of PTLD were 76.3% and 92.5%, while the negative predictive value and PPV of VL were 94.9% and 68.4%, respectively. Combining elevated IL-6 with high VL increased the PPV and specificity to 80% and 96.2%, respectively, and improved the receiver operating characteristic curve. Serum IL-6 levels can improve the clinician's ability to identify PTLD, among patients with elevated EBV viral loads.
authors.affiliation: Division of Infectious Disease, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Barton
authors.forename: S
authors.initials: S
authors.lastname: Wasfy
authors.forename: D
authors.initials: D
authors.lastname: Hébert
authors.forename: A
authors.initials: A
authors.lastname: Dipchand
authors.forename: A
authors.initials: A
authors.lastname: Fecteau
authors.forename: D
authors.initials: D
authors.lastname: Grant
authors.forename: V
authors.initials: V
authors.lastname: Ng
authors.forename: M
authors.initials: M
authors.lastname: Solomon
authors.forename: M
authors.initials: M
authors.lastname: Chan
authors.forename: S
authors.initials: S
authors.lastname: Read
authors.forename: D
authors.initials: D
authors.lastname: Stephens
authors.forename: R
authors.initials: R
authors.lastname: Tellier
authors.forename: U D
authors.initials: UD
authors.lastname: Allen
mesh_terms: D000293:Adolescent; D019540:Area Under Curve; D015415:Biomarkers / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D004854:Herpesvirus 4, Human / Q000378:metabolism*; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood*; D007223:Infant; D015850:Interleukin-6 / Q000097:blood*; D007963:Leukocytes, Mononuclear / Q000166:cytology; D008214:Lymphocytes / Q000378:metabolism / Q000821:virology*; D008232:Lymphoproliferative Disorders / Q000097:blood* / Q000821:virology*; D008297:Male; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013602:T-Lymphocytes, Cytotoxic / Q000166:cytology; D019562:Viral Load
chemical_list: D015415:Biomarkers; D015850:Interleukin-6; D007073:Immunoglobulin E