The evaluation of cytokines in predicting the organ injury of critically pediatric patients: a retrospective study

Abstract

Background: The current early warning model for organ damage in critically ill patients has certain limitations. Based on the pathological mechanism, the establishment of an early warning system for organ damage in critically ill children using cytokines profile has not been explored. The aim of this study is to explore the predicting value of cytokines in critically ill patients.

Methods: There were 200 critically pediatric patients and 49 general patients between August 22, 2018 and April 28, 2023 from Children's Hospital of Soochow University enrolled in this study. The clinical information was retrospectively collected and analyzed. The cytokine profiles of these patients were detected by flow cytometry. Receiver operating characteristic (ROC) curves were plotted to determine the association between the cytokines and organ injury.

Results: There were no statistically significant differences in gender, age and underlying disease between critically ill patients and general patients. The interleukin (IL)-6 (P<0.001), IL-10 (P<0.001), IL-17A (P=0.001), tumor necrosis factor-α (TNF-α) (P=0.02) and interferon-γ (IFN-γ) (P=0.02) level in the critically patients were significantly higher than those in the general patients. The results showed that the incidence of acute gastrointestinal injury (AGI) and acute kidney injury (AKI) in critically ill patients was 39% and 23.5%, respectively. Moreover, there were 4% and 3.5% patients with the occurrence of cardiac arrest and acute live injury. The IFN-γ level was increased in these patients with acute liver injury compared to those without these organ injuries, but reduced in the patients with AGI compared to those without. The patients with AKI showed a significant increase in IL-10 in contrast to those without. The IL-2, IL-4, IL-6, IL-10 and IL-17A were higher in patients with acute liver failure (ALF), but TNF-α was reduced, compared to those without. The IL-2, IL-4, IL-6 and IL-10 were significantly increased in the patients with cardiac arrest compared to those without. When IL-10 was higher than 279.45 pg/mL, the sensitivity and specificity for predicting cardiac arrest were 0.875 and 0.927, respectively. While the sensitivity and specificity of IL-6 (more than 1,425.6 pg/mL) were 0.625 and 0.844, respectively. However, no synergistic effect of IL-6 and IL-10 was observed for predicting cardiac arrest. Additionally, the IL-17A (more than 21.6 pg/mL) was a good predictor for the incidence of ALF (sensitivity =0.714, specificity =0.876).

Conclusions: The cytokines profile was different between critically ill patients with organ injury and those without organ injury. The IL-6 and IL-10 levels were good predictors for cardiac arrest in critically ill patients. Additionally, higher IL-17A predicted the incidence of ALF of the critically ill patients.

Keywords: Multiple organ dysfunction syndrome (MODS); cardiac arrest; critically ill patients; cytokines.

Figure 1

The flow chart of this study.

Figure 2

The comparation of cytokines between critically ill patients and general patients. (A) IL-2, (B) IL-4, (C) IL-6, (D) IL-10, (E) TNF-α, (F) IFN-γ, (G) IL-17A were compared in these two groups, respectively. Note: general patients (control), critically ill patients (critical). The cytokine levels were log-transformed, and then the differences of cytokines between the control and the critically ill group were compared using the t-test. *, P<0.05; **, P<0.01; ***, P<0.001. IL, interleukin; TNF-α, tumor necrosis factor-α; IFN-γ, interferon-γ.

Figure 3

The predicting value of cytokines were assessed. (A) The predicting value of IL-6 and IL-10 for the incidence of cardiac arrest; (B) The predicting value of IL-17A for acute liver failure. IL, interleukin.