title: Serum soluble ST2 as diagnostic marker of systemic inflammatory reactive syndrome of bacterial etiology in children.
abstract: BACKGROUND
  Accurate and timely diagnosis of community-acquired bacterial versus viral infections in children with systemic inflammatory response syndrome (SIRS) remains challenging both for clinician and laboratory. In the quest of new biochemical markers to distinguish bacterial from viral infection, we have explored the possible role of the soluble secreted form of ST2 (sST2).
  
  
  METHODS
  This explorative prospective cohort study included children with SIRS who were suspected of having community-acquired infections. Plasma samples for sST2 measurement were obtained from 64 hospitalized children, 41 of whom had SIRS of bacterial etiology and 23 SIRS of viral etiology, and from 20 healthy, age- and sex-matched control children. sST2 measurement was carried out by enzyme-linked immunosorbent assay in parallel with standard measurements of procalcitonin (PCT) and C reactive protein (CRP).
  
  
  RESULTS
  Our findings demonstrate that children with SIRS associated with bacterial infection present significantly increased levels of sST2, when compared with patients with SIRS of viral etiology and healthy children. More important, receiver operating characteristic curve analysis indicated that sST2 has a significant diagnostic performance with respect to early identification of SIRS of bacterial etiology, which was similar to that of PCT and greater than that of CRP. Finally, the combination of sST2 plus PCT and/or CRP, and PCT plus CRP increased their sensitivity and negative predictive value compared with sST2, PCT and CRP alone.
  
  
  CONCLUSIONS
  In conclusion, sST2 level may prove useful in predicting bacterial etiology in children with SIRS.
authors.affiliation: From the *Immunological and Infectious Disease Unit, University Department of Pediatrics, Bambino Gesù Children's Hospital; †General Pediatrics and Infectious Disease Unit, Department of Pediatrics, Bambino Gesù Children's Hospital; ‡Department of Pediatric Hematology and Oncology, Bambino Gesù Children's Hospital; §Department of Internal Medicine, University of Tor Vergata; and ¶Clinical Trial Unit, University Department of Pediatrics, Bambino Gesù Children's Hospital, Rome, Italy.
authors.forename: Francesca Ippolita
authors.initials: FI
authors.lastname: Calò Carducci
authors.forename: Lelia Rotondi
authors.initials: LR
authors.lastname: Aufiero
authors.forename: Laura
authors.initials: L
authors.lastname: Folgori
authors.forename: Anna Chiara
authors.initials: AC
authors.lastname: Vittucci
authors.forename: Donato
authors.initials: D
authors.lastname: Amodio
authors.forename: Maia
authors.initials: M
authors.lastname: De Luca
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Li Pira
authors.forename: Alberto
authors.initials: A
authors.lastname: Bergamini
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Pontrelli
authors.forename: Andrea
authors.initials: A
authors.lastname: Finocchi
authors.forename: Patrizia
authors.initials: P
authors.lastname: D'Argenio
mesh_terms: D015415:Biomarkers / Q000097:blood; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D000072179:Interleukin-1 Receptor-Like 1 Protein; D008297:Male; D011446:Prospective Studies; D012372:ROC Curve; D011956:Receptors, Cell Surface / Q000097:blood*; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood* / Q000382:microbiology* / Q000821:virology
chemical_list: D015415:Biomarkers; C079241:IL1RL1 protein, human; D000072179:Interleukin-1 Receptor-Like 1 Protein; D011956:Receptors, Cell Surface