Performance of interleukin-27 as a sepsis diagnostic biomarker in critically ill adults.
OBJECTIVE
We recently identified interleukin-27 (IL-27) as a sepsis diagnostic biomarker in children. Here we assess IL-27 as a sepsis diagnostic biomarker in critically ill adults with systemic inflammatory response syndrome and sepsis.


METHODS
IL-27 and procalcitonin (PCT) were measured from plasma samples in three groups: no sepsis (n = 78), pulmonary source of sepsis (n = 66), and non-pulmonary source of sepsis (n = 43). Receiver operating characteristic curves and classification and regression tree methodology were used to evaluate biomarker performance.


RESULTS
IL-27 did not discriminate effectively between sepsis and sterile systemic inflammatory response syndrome in unselected patients. The highest area under the curve (AUC) was 0.70 (95% C.I. 0.60 - 0.80) for IL-27 in subjects with a non-pulmonary source of sepsis. A decision tree incorporating IL-27, PCT, and age had an AUC of 0.79 (0.71-0.87) in subjects with a non-pulmonary source of sepsis. Compared to children with sepsis, adults with sepsis express less IL-27.


CONCLUSIONS
IL-27 performed overall poorly in this cohort as a sepsis diagnostic biomarker. Combining IL-27, PCT, and age reasonably estimated the risk of sepsis in subjects with a non-pulmonary source of sepsis. IL-27 may be a more reliable sepsis diagnostic biomarker in children than in adults.
Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center and Cincinnati Children's Hospital Research Foundation, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA. Electronic address: hector.wong@cchmc.org.
Hector R
HR
Wong
Departments of Medicine and Anesthesia, University of California, San Francisco, San Francisco, CA, USA.
Kathleen D
KD
Liu
Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
Kirsten N
KN
Kangelaris
Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center and Cincinnati Children's Hospital Research Foundation, Cincinnati, OH, USA.
Patrick
P
Lahni
Departments of Medicine and Anesthesia, University of California, San Francisco, San Francisco, CA, USA.
Carolyn S
CS
Calfee
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D016638:Critical Illness; D003663:Decision Trees; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D064094:Interleukin-27 / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011498:Protein Precursors / Q000097:blood*; D012372:ROC Curve; D012141:Respiratory Tract Infections / Q000097:blood*; D018805:Sepsis / Q000097:blood / Q000175:diagnosis*; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood / Q000175:diagnosis
D015415:Biomarkers; C000606589:CALCA protein, human; D064094:Interleukin-27; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide
Biomarkers; Diagnosis; Infection; Interleukin 27; Procalcitonin; Sepsis