High-mobility group box-1 protein, lipopolysaccharide-binding protein, interleukin-6 and C-reactive protein in children with community acquired infections and bacteraemia: a prospective study

Abstract

IntroductionEven though sepsis is one of the common causes of children morbidity and mortality, specific inflammatory markers for identifying sepsis are less studied in children. The main aim of this study was to compare the levels of high-mobility group box-1 protein (HMGB1), Lipopolysaccharide-binding protein (LBP), Interleukin-6 (IL-6) and C-reactive protein (CRP) between infected children without systemic inflammatory response syndrome (SIRS) and children with severe and less severe sepsis. The second aim was to examine HMGB1, LBP, IL6 and CRP as markers for of bacteraemia.MethodsTotally, 140 children with suspected or proven infections admitted to the Children's Clinical University Hospital of Latvia during 2008 and 2009 were included. Clinical and demographical information as well as infection focus were assessed in all patients. HMGB1, LBP, IL-6 and CRP blood samples were determined. Children with suspected or diagnosed infections were categorized into three groups of severity of infection: (i) infected without SIRS (n = 36), (ii) sepsis (n = 91) and, (iii) severe sepsis (n = 13). They were furthermore classified according bacteraemia into (i) bacteremia (n = 30) and (ii) no bacteraemia (n = 74).ResultsThere was no statistically significant difference in HMGB1 levels between children with different levels of sepsis or with and without bacteraemia. The levels of LBP, IL-6 and CRP were statistically significantly higher among patients with sepsis compared to those infected but without SIRS (p < 0.001). Furthermore, LBP, IL-6 and CRP were significantly higher in children with severe sepsis compared to those ones with less severe sepsis (p < 0.001). Median values of LBP, IL6 and CRP were significantly higher in children with bacteraemia compared to those without bacteraemia. The area under the receiver operating curve (ROC) for detecting bacteraemia was 0.87 for both IL6 and CRP and 0.82 for LBP, respectively.ConclusionElevated levels of LBP, IL-6 and CRP were associated with a more severe level of infection in children. Whereas LBP, IL-6 and CRP seem to be good markers to detect patients with bacteraemia, HMGB1 seem to be of minor importance. LBP, IL-6 and CRP levels may serve as good biomarkers for identifying children with severe sepsis and bacteraemia and, thus, may be routinely used in clinical practice.

Diagnostic value of serum concentrations of high‐mobility group‐box protein 1 and soluble hemoglobin scavenger receptor in brucellosis

“…have also shown that increases in HMGB1 concentrations, but not in those of sCD163, correlate with WBC counts and concentrations of other proinflammatory indicators and CRP . CRP is reportedly significantly positively correlated with serum HMGB1 concentrations according to some studies ; however, others found no correlations between HMGB1 and CRP . Neither HMGB‐1 nor sCD163 concentrations correlated with WBC count and CRP in our study.…”

Bacterial enteric pathogens and serum interleukin-6 levels in children with acute diarrhea

“…The best cut-off used in this study was 15 pg/mL, which gave a sensitivity of 75% and a specificity of 91% for confirming bacterial infection. Previous reports suggested that serum cytokines appeared in a temporal sequence after endotoxin injection 21 serum IL-6 levels between groups in which blood was drawn earlier (0-36 hours) compared to those who were sampled later (36-72 hours). 20 This observation implies that IL-6 has a tendency to be present in the circulation for a considerable length of time following infection.…”

Use of biomarkers in pediatric sepsis: literature review

“…IL-6 serum levels are higher in children diagnosed with sepsis than in patients with noninfectious systemic inflammation only, (43,44) and its diagnostic accuracy increases when combined with other diagnostic biomarkers, including CRP, for example. (43) Furthermore, among children with sepsis, an increase in IL-6 level is associated with more severe cases, (45) and its use in clinical practice can provide a good predictor of severe sepsis.…”