Retrospective Study On The Predictive Value Of Th1/Th2 Cytokines In Pediatric Hematology-oncology Patients With Sepsis For The Severity And Treatment

Object:To investigate the Thl/Th2 cytokines in children with sepsis and analyze the prognostic significance for the severity and glucocorticoid treatment.Methods:Six cytokine levels including IL-2,IL-4.IL-6.IL-10,TNF and IFN-γfrom 323 sepsis children with hematological diseases diagnosed and treated in Hematology/Oncology Department of the Children's Hospital of Zhejiang University School of Medicine from January 1,2006 through February 28,2011 was determined by cytometrical bead array (CBA) technology at the onset of fever.100 pediatric hematology-oncology patients without infection were collected and analyzed as control. Groups:sepsis group (n=323) and control group (n=100). Among 323 septic patients.99 suffered from septic shock (sepsis group=99) and 224 without (none shock group= 224);10 children died from septic shock(death group (n=10) and survival group (n=313);intermediate to high dose methyl prednisolone (MethP) was administered at early stage of shock right after volume expansion for 60 patients with shock (MethP group=60), while immediate administration of vasoactive agents followed volume expansion without steroids was allocated to Dopamine group (n=26). In 23 patients of MethP group, concentrations of these cytokines were also detected immediately after shock reversal. Cytometric bead array (CBA) technology was applied to detect cytokines concentrations.Results:The median levels of IL-2,IL-4,IL-6,IL-10,TNF and IFN-γin sepsis group (2.9,3.0,235.3,43.9,4.5,8.6pg/ml, n=323) were significantly higher than control group (2.2,1.9,6.8,5.2,2.5,2.9pg/ml, n=100) (P<0.01). Median levels of IL-6 and IL-10 in septic shock patients (n=99) were markedly higher than those without septic shock (n=224) (434.2pg/ml vs 171.0pg/ml, P<0.01; 96.3pg/ml vs 34.1pg/ml, P<0.01). IL-6≥415 pg/ml and IL-10≥98 pg/ml was a predictive profiling for septic shock as it increased the incidence of septic shock (40.0% vs 20.0%, P<0.01). IL-6 level was in a positive correlation with mortality. Shorter shock duration (median 1.5 days vs 3.5 days, P<0.01) and lower mortality (0/60 vs 10/26. P<0.01) were observed in MethP group (n=60), compared with Dopamine group (n=26). In 23 septic shock patients with methyl prednisolone as first line treatment, median levels of IL-6 (795.6pg/ml vs 7.5pg/ml, P<0.01). IL-10 (215.4pg/ml vs 5.6pg/ml, P<0.01) and TNF (5.1 pg/ml vs 2.1 pg/ml, P<0.01) dramatically decreased as shock recovered.Conclusions:Significantly increased levels of IL-6 and IL-10 are useful predictors for evaluation of severity in septic children and IL-6 can be regarded as a good predictor of mortality. Early use of exogenous glucocorticoid with short duration is strongly recommended for septic shock and it is expected to shorten the shock duration and reduce the mortality rate significantly.