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- Title
Interleukin 6 as a marker of severe bacterial infection in children with sickle cell disease and fever: a case-control study.
- Authors
Rincón-López, Elena María; Navarro Gómez, María Luisa; Hernández-Sampelayo Matos, Teresa; Aguilera-Alonso, David; Dueñas Moreno, Eva; Saavedra-Lozano, Jesús; Santiago García, Begoña; Santos Sebastián, María del Mar; García Morín, Marina; Beléndez Bieler, Cristina; Lorente Romero, Jorge; Cela de Julián, Elena; F-DREP Study Group; Hernanz Lobo, Alicia; Garrido Colino, Carmen; Huerta Aragonés, Jorge; Mata Fernández, Cristina; Bardón Cancho, Eduardo; Míguez Navarro, Concepción; Mora Capín, Andrea
- Abstract
<bold>Background: </bold>Etiological diagnosis of fever in children with sickle cell disease (SCD) is often challenging. The aim of this study was to analyze the pattern of inflammatory biomarkers in SCD febrile children and controls, in order to determine predictors of severe bacterial infection (SBI).<bold>Methods: </bold>A prospective, case-control study was carried out during 3 years, including patients younger than 18 years with SCD and fever (cases) and asymptomatic steady-state SCD children (controls). Clinical characteristics and laboratory parameters, including 10 serum proinflammatory cytokines (IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12p70, IL-17a, IFN-γ and TNF-α) and comparisons among study subgroups were analyzed.<bold>Results: </bold>A total of 137 patients (79 cases and 58 controls) were included in the study; 78.5% males, median age 4.1 (1.7-7.5) years. Four cases were diagnosed with SBI, 41 viral infection (VI), 33 no proven infection (NPI) and 1 bacterial-viral coinfection (the latter excluded from the subanalyses). IL-6 was significantly higher in patients with SBI than in patients with VI or NPI (163 vs 0.7 vs 0.7 pg/ml, p < 0.001), and undetectable in all controls. The rest of the cytokines analyzed did not show any significant difference. The optimal cut-off value of IL-6 for the diagnosis of SBI was 125 pg/mL, with high PPV and NPV (PPV of 100% for a prevalence rate of 5, 10 and 15% and NPV of 98.7%, 97.3% and 95.8% for those prevalences rates, respectively).<bold>Conclusion: </bold>We found that IL-6 (with a cut-off value of 125 pg/ml) was an optimal marker for SBI in this cohort of febrile SCD children, with high PPV and NPV. Therefore, given its rapid elevation, IL-6 may be useful to early discriminate SCD children at risk of SBI, in order to guide their management.
- Subjects
SICKLE cell anemia; BACTERIAL diseases; CASE-control method; DIAGNOSIS; FEVER; DIAGNOSIS of bacterial diseases; INTERLEUKINS; RESEARCH funding; LONGITUDINAL method; DISEASE complications
- Publication
BMC Infectious Diseases, 2021, Vol 21, Issue 1, p1
- ISSN
1471-2334
- Publication type
journal article
- DOI
10.1186/s12879-021-06470-4