Study On The Correlation Between Neutrophil Count And Inflammatory Response In Pediatric Hematology/Oncology Patients With Infections

ObjectivesChemotherapy is the main treatment of blood tumor in children,can cause bone marrow suppression,make granulocytopenia,making blood tumor chemotherapy period children are more likely to secondary infection,and has high mortality.This early research team found that cytokines(interleukin(IL)-6,IL-10,tumor necrosis factor(TNF)-alpha and interferon(IFN)-gamma),former calcitonin(PCT)and c-reactive protein(CRP)is a commonly used indicator of infection,can be used in the identification and early diagnosis of infection type.,but our prophase research found in all kinds of rules also apply to the tumor in children with blood,and the grain of children and the grain of affluent children whether there is a difference in the process of the inflammatory response is not yet known.Therefore,this study analyzed retrospectively from 2014 to 2016 children with fever related indicators,compare granulocyte levels correlated with various indicators of inflammation,in order to make clear the influence of granulocyte level immune response to infection.MethodsThe study is a retrospective study.The samples are derived from hospitalized hematology/oncology children in our department from October,2014 to September,2016.When the children got febrile,the tests were taken with collected venous blood,including C-reactive protein(CRP),PCT,cytokine levels(IL-6.IL-10?TNF-??IFN-?)and blood culture.All statistical analysis were performed with SPSS software.and measurement data expressed with median(range).Continuous variables were analyzed using Mann-Whitney U-test while Kruskal-Wallis U-test was used among more than two groups.Receiver operating characteristic curves(ROC)were derived from cytokine levels and PCT levels for predicting the accuracy of the diseases of septic shock and Galas negative bacterial infection.A two-sided P-value of<0.05 was considered to be statistically significant.Results3118 febrile episodes were include in our study work.Patients lack of granulocyte account for 64.9%.Their febrile state were caused by unknown causes 40%,respiration system infections 34.8%,bloodstream infections 15.7%and others 9.1%.For the counterpart with enough granulocyte levels,the febrile state were caused by unknown causes 25.2%,respiration system infections 56%bloodstream infections 8.4%and others 10.4%.The rate of bloodstream infection was significantly increased in the granulocytes(15.6%vs.8.4%,P<0.001),but the rate of respiratory infection was relatively low(34.8%vs.56%,P<0.001).The incidence of septic shock in patients with bloodstream infection increased significantly(11.2%),suggesting a severe type of infection.11-6(median,same as 179.3pg/ml vs.52.9pg/ml,P<0.001),il-10(22.3pg/ml vs.6.3pg/ml,P<0.001),TNF-(2.7pg/ml vs.2.3pg/ml,P<0.001),and PCT(0.31ng/ml vs.0.21ng/ml).However,CRP and ifn-count have no significant differences.Comparison between granulocyte lack,granulocyte lack group various inflammatory factor levels found,IL-6 in the bloodstream infections(59.4 pg/ml vs.44.7 pg/ml,P<0.001),and bloodstream infections(190.1 pg/ml vs.133.9 pg/ml,P = 0.115)and septic shock(816.1 pg/ml vs.360.8 pg/ml,P = 0.042)are in the form of bead deficiency was not short of higher or corresponding trend;Il-10 was high in non-granulocytic infection(5.85pg/ml vs 7.2pg/ml,P<0.001),but opposite in bloodstream infection(32.35pg/ml vs 12.8pg/ml,P=0.022)and infectious shock(223.1pg/ml vs 50.6pg/ml,P=0.026).TNF-? and IFN-Y are in non-blood stream infections(TNF-?:2.2pg/ml vs.2.4pg/ml,P=0.028.IFN-?:7.2pg/ml vs.8.4pg/ml,P<0.001)and blood flow infections(TNF-a:2.65pg/ml vs.2.8pg/ml,P<0.001.IFN-?:7.1pg/ml vs.14.5pg/ml,P<0.001).The increase in non-deficient children was more significant in all.The performance of CRP was consistent with il-6,while PCT showed no difference in each group.IL-6,IL-10,the accuracy of the prediction of gram-negative bacteria infection were 0.787(95%CI,0.754 0.819),0.754(95%CI,0.794 0.861),the prediction accuracy of septic shock were 0.888(95%CI,0.861 0.914),0.861(95%CI,0.828 0.903),significantly higher than that of PCT and CRP.ConclusionsChildren with granulocytosis have an increased chance of bloodstream infection and septic shock.The increase of TNF-and IFN-dependence was more significant in patients with higher granulocyte level than in those with other infections other than infectious shock.However,the production of il-10 and il-6 increased significantly in severe infections such as bloodstream infection and septic shock compared with those in non-granulocytic children.The expression of CRP was consistent with il-6,while the increase of PCT was independent of granulocyte level.The different reactions of the above inflammatory factors may be related to the rate of bacterial clearance and the degree of inflammation.In addition,il-6 and il-10 were better than PCT and CRP in predicting severe infection.