A multiplex cytokine score for the prediction of disease severity in pediatric hematology/oncology patients with septic shock.
Although many inflammatory cytokines are prognostic in sepsis, the utility of cytokines in evaluating disease severity in pediatric hematology/oncology patients with septic shock was rarely studied. On the other hand, a single particular cytokine is far from ideal in guiding therapeutic intervention, but combination of multiple biomarkers improves the accuracy. In this prospective observational study, 111 episodes of septic shock in pediatric hematology/oncology patients were enrolled from 2006 through 2012. Blood samples were taken for inflammatory cytokine measurement by cytometric bead array (CBA) technology at the initial onset of septic shock. Interleukin (IL)-6 and IL-10 were significantly elevated in majority of patients, while tumor necrosis factor (TNF)-α and interferon (IFN)-γ were markedly increased in patients with high pediatric index of mortality 2 (PIM2) score and non-survivors. All the four cytokines paralleled the PIM2 score and differentially correlated with hemodynamic disorder and fatal outcomes. The pediatric multiplex cytokine score (PMCS), which integrated the four cytokines into one score system, was related to hemodynamic disorder and mortality as well, but showed more powerful prediction ability than each of the four cytokines. PMCS was an independent predictive factor for fatal outcome, presenting similar discriminative power with PIM2, with accuracy of 0.83 (95% CI, 0.71-0.94). In conclusion, this study develops a cytokine scoring system based on CBA technique, which performs well in disease severity and fatality prediction in pediatric hematology/oncology patients with septic shock.
Division of Hematology-Oncology, Children's Hospital of Zhejiang University School of Medicine, Hangzhou 310003, PR China; Key Laboratory of Reproductive Genetics (Zhejiang University), Ministry of Education, Hangzhou 310003, PR China.
Xiao-Jun
XJ
Xu
Yong-Min
YM
Tang
Hua
H
Song
Shi-Long
SL
Yang
Wei-Qun
WQ
Xu
Shu-Wen
SW
Shi
Ning
N
Zhao
Chan
C
Liao
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016207:Cytokines / Q000097:blood*; D005260:Female; D006402:Hematologic Diseases / Q000097:blood*; D006801:Humans; D007223:Infant; D018836:Inflammation Mediators / Q000097:blood; D053208:Kaplan-Meier Estimate; D008297:Male; D009369:Neoplasms / Q000097:blood*; D011379:Prognosis; D016016:Proportional Hazards Models; D012372:ROC Curve; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000097:blood* / Q000401:mortality / Q000473:pathology*
D016207:Cytokines; D018836:Inflammation Mediators
AUC; Child; Cytokine; FCM; Hematology/oncology; IFN; IL; Outcome assessment; PIM2; PMCS; ROC; Septic shock; TNF; area under curve; flow cytometry; interferon; interleukin; pediatric index of mortality 2; pediatric multiple cytokine score; receiver operating characteristics; tumor necrosis factor