DOI: https://doi.org/10.22141/2312-413x.6.1.2018.125634

Diagnostic value of modern biomarkers for the development of purulent-bacterial diseases in children

L.V. Pypa, M.M. Murhina, R.V. Svistilnik

Abstract


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.


Keywords


children; sepsis; localized bacterial infection; С-reactive protein; tumor necrosis factor α; procalcitonin; presepsin

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