Evaluation of BCL2 and TNFα as mRNA biomarkers for monitoring the immune response in critically ill children.
Ann Med Surg (Lond)
; 36: 122-128, 2018 Dec.
Article
em En
| MEDLINE
| ID: mdl-30455877
ABSTRACT
BACKGROUND:
Hospital acquired infection (HAI) and multiple organ dysfunctions (MODS) remain a leading cause of death in pediatric intensive care unit (PICU) despite the great efforts to control it.OBJECTIVE:
Our objective was to assess the mRNA of TNFα and BCL2 for prediction of HAI and/or MODS in our community. PATIENTS ANDMETHODS:
Fifty children, admitted to PICU, were included in the study after exclusion of cases of end-stage renal failure, end-stage liver failure and congenital immune deficiency. Serial Blood samples were collected for complete blood count (CBC) and other routine investigations. Gene expression of (TNFα and BCL2) was quantified using quantitative real time PCR (qRT-PCR). Centers of disease control (CDC) criteria were used to detect HAI, and organ failure index (OFI). Pediatric logistic organ dysfunction (PELOD) and pediatric risk of mortality (PRISM) scores were used for follow up. The results were compared between the group who acquired HAI and who didn't. Gene expression was tested with a ROC curve to detect its ability to predict HAI. MAINRESULTS:
The overall complication (HAI and/or MODS) rate was 52%, Complicated cases had a significantly longer duration of stay in PICU (0.002) and in overall hospital stay (pâ¯=â¯0.013) and a higher death rate (pâ¯=â¯0.000). On day1; TNFα, BCL2 and lymphocytic count were lower in patients who developed complications (pâ¯=â¯0.02, pâ¯=â¯0.000 and pâ¯=â¯0.04, respectively), all had the ability to predict the complications with AUC (0.7, 0.8 and 0.67 respectively). On day 4 TNFα and BCL2 returned to normal levels while the lymphocytic count still lower in complicated cases, pâ¯=â¯0.001 and AUCâ¯=â¯0.73.CONCLUSIONS:
TNFα and BCL2 on admission can predict HAI and MODS (AUCâ¯=â¯0.7 and AUCâ¯=â¯0.8), but were of no use in the follow-up, however, the lymphocytic count is a rapid, easy and cheap test to assess the immune state with a good predictive and follow up values.
AUC, Area under the curve; BCL2; BCL2, B-cell lymphoma 2; CARS, Compensatory anti-inflammatory syndrome; CDC, Centers for disease control; Critical illness; HAI, Hospital acquired infection; MODS; MODS, Multiple organ dysfunctions; OFI, Organ failure index; PELOD, Pediatric logistic organ dysfunction; PICU, pediatric intensive care unit; Prediction of HAI; Quantitative real time PCR; ROC, Receiver operating characteristics; TNFα; TNFα, Tumor necrosis factor alpha; cDNA, Complementary DNA; qRT-PCR, quantitative real time PCR
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Tipo de estudo:
Prognostic_studies
Idioma:
En
Revista:
Ann Med Surg (Lond)
Ano de publicação:
2018
Tipo de documento:
Article
País de afiliação:
Egito