Evaluation Effect Of Inflammatory Response Typing Based On Cytokines On The Condition And Prognosis Of Children With Sepsis

Objective: To evaluate the effect of serum cytokines and inflammatory response typing based on cytokine definition on the severity and prognosis of children with sepsis.evaluate the effect of serum cytokines and immunotyping based on cytokine status on the severity and prognosis of children with sepsis.Methods: A total of 176 children with sepsis admitted to the PICU of Hunan Children’s Hospital from May 2018 to May 2019 were included.Clinical data and laboratory examination results of the children within 24 hours of admission were collected.Meanwhile,blood samples were tested for serum interleukin-2(IL-2),interleukin-4(IL-4),interleukin-6(IL-6),interleukin-10(Interleukin-10),Tumor necrosis factor-α(TNF-α),Interferon γ(IFN-γ).According to the consensus diagnostic criteria of pediatric septic shock diagnosis and treatment experts in 2015,the children were divided into the sepsis group and the severe sepsis group.According to the prognosis at 28 days,they were divided into survival group and death group.The inflammatory response was classified according to the common clinical cytokine status.It can be divided into systemic inflammatory response syndrome(SIRS)and compensatory anti-inflammatory response syndrome(CARS)and mixed antagonistic response syndrome(MARS).The statistical differences of general laboratory examination results and hospitalization of children in different groups were compared to explore the role of cytokine and inflammatory response typing in the evaluation of the condition and prognosis of children with sepsis.Results: 1.A total of 176 children with sepsis were included in this study.According to the severity,109 children were divided into the sepsis group and 67 children were divided into the severe sepsis group.According to the prognosis at 28 days,the patients were divided into survival group155 cases and death group 21 cases.There was no significant difference in age and sex ratio among all groups.The median length of hospital stay of enrolled children was 15 days,and the median length of hospital stay of PICU was 8.5 days.The primary site of infection was the lower respiratory tract,followed by the nervous system and digestive system.The indexes of organ function,P-SOFA and PELOD2 in the severe group and the death group were higher than those in the sepsis group and the survival group.2.Serum concentrations of cytokines IL-6 and IL-10 in the severe sepsis group were significantly higher than those in the sepsis group,and the levels of IL-10 and TNF-α in the death group were significantly higher than those in the survival group,with statistical differences(P<0.05).3.Typing of septic inflammatory response by cytokines,there were 131 cases of SIRS status,37 cases of CARS status,and 8 cases of MARS status in the enrolled children.There were statistical differences in the composition of inflammatory response state between the groups of severity and prognosis(P<0.05).With SIRS as the control group,CARS had a higher risk of severe sepsis(OR=6.48,95%CI: 2.901 ～ 14.489)and death(OR=5.69,95%CI: 2.056 ～ 15.772).MARS was associated with a higher risk of severe sepsis(OR=8.23,95%CI: 1.586 ～ 42.693)and death(OR=9.23,95%CI: 1.862-45.694),with statistical differences.Conclusions:1.The concentration of the cytokine IL-6 and IL-10 was associated with the severity of the disease in children with sepsis,and the elevated level of IL-10 and TNF-α was associated with poor prognosis.2.The majority of children with sepsis were SIRS,and the proportion of CARS and MARS in severe sepsis was higher.It can be seen that children with severe sepsis are prone to the immune disorders of pro-inflammatory combined with anti-inflammatory(CARS/MARS).3.Immune disorders associated with pro-inflammatory combined with anti-inflammatory(CARS/ MARS)were associated with poor prognosis of sepsis,and the risk of death of SIRS、CARS、MARS was successively increased.