Diagnostic value of modern biomarkers for the development of purulent-bacterial diseases in children
Background. Sepsis is a general clinical problem with high mortality rate and significant material expenses for the treatment. In this regard, biomarkers are being searched for early diagnosis. Materials and methods. 115 children with generalized and localized forms of bacterial infections were examined. Main group (n = 47) — patients with sepsis, comparison group (n = 68) — persons with bacterial infection of various localization. The age of children was from 1 month to 18 years. Distribution was performed according to the presence of signs and symptoms of systemic inflammation response syndrome and organ dysfunction. Control group — 57 apparently healthy children. Patients underwent determination of С-reactive protein (CRP), tumor necrosis factor (TNF-α), procalcitonin and presepsin levels in the blood serum. Results. After the performed studies, it was found that the concentration of CRP in children with sepsis was 44.7 mg/l (95% confidence interval (CI) 35.0–54.3). In children with localized bacterial infection — 28.3 mg/l (95% CI 22.4–34.2; p < 0.01); with the increase in the severity of the state, the concentration of CRP increases, but statistically significant difference (p < 0.05) is found only in children with 2 or more signs of systemic inflammation response syndrome. For the differential diagnosis of localized and generalized bacterial infection, TNF-α was studied, its average level in children of the main group was 280.3 pg/ml (95% CI 243.9–316.7), which was 1.5 times higher than in patients with localized bacterial process, where the average level of the given cytokine was 186.5 pg/ml (95% CI 163.1–209.9), and 4.2 times higher compared to the control group (65.7 pg/ml (95% CI 56.7–74.8). In children from the comparison group, TNF-α levels were 2.8 times higher when compared with apparently healthy children. The difference between groups was statistically significant (p < 0.01). In the main group, the mean procalcitonin level was 4.06 ng/ml (95% CI 3.34–4.69), in the comparison group — 0.86 ng/ml (95% CI 0.77–1.03), and in the control group — 0.024 ng/ml (95% CI 0.02–0.03), the difference between groups was statistically significant (p < 0.01). In the main group, the presepsin level was 1887.5 pg/ml (505.5–3702.5 pg/ml); in the comparison group — 313.5 pg/ml (208–376 pg/ml). The difference between the groups according to the Mann-Whitney U test is statistically significant (p < 0.01). In healthy children (n = 26, control group), the level of presepsin was 109 pg/ml (77.5–160 pg/ml), which also statistically differed from the median of the comparison group (p < 0.05): Mann — Whitney U test — 15 at critical significance of 112. For the diagnosis of bacterial infection in children, the sensitivity of presepsin is the highest and is 97 %, specificity — 96 %. The sensitivity and specificity of presepsin levels in children with sepsis are 92 and 93 %, respectively. Conclusions. The most reliable markers for the diagnosis of sepsis are procalcitonin and presepsin levels in the blood serum, since their sensitivity and specificity are the highest.
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