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Inflammatory cytokine measurement quickly discriminates gram-negative from gram-positive bacteremia in pediatric hematology/oncology patients with septic shock

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Abstract

Purpose

We performed a prospective study to evaluate the ability of inflammatory cytokines in discriminating gram-negative from gram-positive bacteremia in septic shock.

Methods

During the study period, the serum inflammatory cytokine levels were measured at the onset of septic shock by flow cytometry in pediatric hematology/oncology patients with septic shock.

Results

One hundred episodes of septic shock were enrolled. Of 97 episodes of monomicrobial infection, 73.2 % were caused by gram-negative bacteremia and 26.8 % by gram-positive bacteremia. Interleukin (IL)-6, IL-10, and tumor necrosis factor (TNF)-α were closely related to the pediatric index of mortality 2 (PIM2) score and mortality. However, although the PIM2 score and mortality were comparable, the IL-6, IL-10, and TNF-α levels were significantly higher in patients with gram-negative bacteremia (GNB) than those with gram-positive bacteremia (median levels, pg/mL: IL-6: 784.1 vs. 254.4, P = 0.001; IL-10: 192.2 vs. 19.7, P < 0.001; TNF-α: 4.2 vs. 2.0, P < 0.001). Of the three cytokines, IL-10 was the most useful biomarker for GNB prediction in the derivation cohort and a cutoff value of 50 pg/mL showed a sensitivity of 70.8 % and a specificity of 80.0 %, with a positive predictive value of 89.5 %. When this cutoff value was applied to the validation cohort, the sensitivity, specificity, and positive predictive value were 80.9, 75.0, and 90.5 %, respectively.

Conclusions

Flow cytometry-based inflammatory cytokine measurement is a helpful adjuvant approach for early and quick discrimination of gram-negative from gram-positive bacteremia in pediatric hematology/oncology patients with septic shock which might be useful for evaluating the severity of shock and the selection and/or timely withdrawal or switch of antibiotics.

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Acknowledgments

This work was supported in part by grants from the National Natural Science Foundation of China (nos. 81170502, 31100638, 30971283), the Zhejiang Provincial Natural Science Foundation of China (nos. Y2110020, LZ12H08001, Z205166), and the Ph.D. Programs Foundation of Ministry of Education of China (20110101120138).

Conflicts of interest

All the authors declare no conflict of interests.

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Authors and Affiliations

  1. Division of Hematology-Oncology, Children’s Hospital of Zhejiang University School of Medicine, Hangzhou, 310003, People’s Republic of China

    Xiao-Jun Xu, Yong-Min Tang, Chan Liao, Hua Song, Shi-Long Yang, Wei-Qun Xu, Shu-Wen Shi & Ning Zhao

  2. Key Laboratory of Reproductive Genetics, Zhejiang University, Ministry of Education, Hangzhou, 310003, People’s Republic of China

    Xiao-Jun Xu, Yong-Min Tang & Ning Zhao

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  1. Xiao-Jun Xu
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  2. Yong-Min Tang
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  3. Chan Liao
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  4. Hua Song
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  7. Shu-Wen Shi
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  8. Ning Zhao
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Correspondence to Yong-Min Tang.

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Xu, XJ., Tang, YM., Liao, C. et al. Inflammatory cytokine measurement quickly discriminates gram-negative from gram-positive bacteremia in pediatric hematology/oncology patients with septic shock. Intensive Care Med 39, 319–326 (2013). https://doi.org/10.1007/s00134-012-2752-4

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  • DOI: https://doi.org/10.1007/s00134-012-2752-4

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