title: Evaluation of Th1/Th2 cytokines as a rapid diagnostic tool for severe infection in paediatric haematology/oncology patients by the use of cytometric bead array technology.
abstract: Haematology/oncology children are usually at risk for various infections after intensive chemotherapy. We evaluated the quantification of Th1/Th2 cytokines with a flow cytometric bead array (CBA) in 795 hospitalized haematology/oncology children (309 febrile and 486 afebrile patients) to seek for a diagnostic method for determination of the type and the severity of infection. Three hundred and nine febrile patients developed a total of 505 febrile episodes. Microbiological examination demonstrated a positive blood culture (microbiologically documented infection (MDI)) in 145/505 febrile episodes. The controls included 550 healthy children, 43 haemophagocytic lymphohistiocytosis (HLH) patients, 35 cytomegalovirus infection patients and 19 Epstein-Barr virus infection patients. Interleukin (IL)-4, IL-6, IL-10, tumour necrosis factor (TNF)-α and interferon (IFN)-γ levels in febrile episodes were significantly higher than those in healthy children, and the cytokine profile was different from that of the HLH controls or the viral infection controls. IL-6 levels were much higher in MDI patients (usually >1000.0 pg/mL, 60/145) than in HLH patients (2/43); however, IFN-γ levels were only slightly increased in MDI patients, rarely being more than 100.0 pg/mL (8/145 vs. 39/43 in HLH patients). The median levels of IL-4, IL-6, IL-10, TNF-α and IFN-γ in febrile patients before antibiotic therapy were 3.9, 660.1, 122.7, 6.9 and 11.4 pg/mL, respectively, and returned to 3.3, 22.8, 9.6, 4.1 and 6.4 pg/mL, respectively, after infection was controlled. IL-6 and IL-10 levels were positively associated with septic shock and mortality rates. In conclusion, our results have demonstrated the usefulness of IL-6/IL-10/TNF-α/IFN-γ determination with CBA technology for the early rapid diagnosis, severity evaluation and assessment of therapy effect in febrile haematology/oncology children.
authors.affiliation: Division of Haematology-Oncology, Zhejiang Key Laboratory for Neonatal Diseases, the Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China. Y_M_TANG@zju.edu.cn
authors.forename: Y
authors.initials: Y
authors.lastname: Tang
authors.forename: C
authors.initials: C
authors.lastname: Liao
authors.forename: X
authors.initials: X
authors.lastname: Xu
authors.forename: H
authors.initials: H
authors.lastname: Song
authors.forename: S
authors.initials: S
authors.lastname: Shi
authors.forename: S
authors.initials: S
authors.lastname: Yang
authors.forename: F
authors.initials: F
authors.lastname: Zhao
authors.forename: W
authors.initials: W
authors.lastname: Xu
authors.forename: X
authors.initials: X
authors.lastname: Chen
authors.forename: J
authors.initials: J
authors.lastname: Mao
authors.forename: L
authors.initials: L
authors.lastname: Zhang
authors.forename: B
authors.initials: B
authors.lastname: Pan
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D019411:Clinical Laboratory Techniques / Q000379:methods*; D016207:Cytokines / Q000097:blood*; D016903:Drug Monitoring / Q000379:methods; D005260:Female; D005335:Fever of Unknown Origin / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology*; D005434:Flow Cytometry / Q000379:methods*; D019337:Hematologic Neoplasms / Q000150:complications*; D006801:Humans; D007223:Infant; D007239:Infections / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology*; D008297:Male; D008863:Microspheres; D012720:Severity of Illness Index
chemical_list: D016207:Cytokines