The diagnostic accuracy of high-mobility group box 1 protein and twelve other markers in discriminating bacterial, viral and co-infected bronchial pneumonia in Han children

Abstract

Pneumonia in children is common and can lead to grave consequences if not addressed in a proper and timely manner. In the management of pneumonia, early identification of the causative infective agent is of obvious importance for treatment, as it allows selection of the appropriate antibiotics. However, such identification requires laboratory test results, which may not be immediately available. The aim of this study was to evaluate the accuracy and usefulness of 13 markers in differentiating between viral and bacterial pneumonia in Han children (34 healthy controls and 78 patients). It was found that WBC counts were more accurate in diagnosis of the type of agent responsible for infection than was the degree of expression of HMGB1. Among the 13 markers investigated, HMGB1 was the best at discriminating between co-infected (bacterium and virus) and single-infected (bacterium or virus) children with bronchial pneumonia. HMGB1 expression of less than 1.0256, excluded most coinfections (the negative predictive value was greater than 89.7%). Diagnosed sole viral pneumonia clinically overlapped with bacterial pneumonia, but bacterial pneumonia was more often associated with higher white blood cell (WBC) counts (WBC ≥ 13,000 cells/mm 3 ). When the two marker readouts-HMGB1 < 1.0256 and WBC ≥ 13,000 cells/mm 3 -were combined, the positive predictive value for bacterial pneumonia alone was 92.3%. These findings can help clinicians discriminate between bronchial pneumonia caused by virus, bacterium or both with a high specificity.Key words bronchial pneumonia, Han children, high-mobility group box 1 protein, white blood cell.Bronchial pneumonia, a pulmonary infection causing inflammation and difficulty in breathing, can be caused by a variety of microorganisms, including viruses, bacteria, fungi, mycoplasma, and parasites. The causes of pediatric pneumonia vary greatly according to age and other risk factors (1-3). Viral pathogens are particularly important

HMGB1 in health and disease

“…Community-acquired pneumonia is pneumonia acquired infectiously from normal social contact, as opposed to being acquired during hospitalization (termed hospital-acquired pneumonia). Increased serum HMGB1 level is caused by bacteria or virus in both community-acquired and hospital-acquired pneumonia (Achouiti et al, 2013; Angus et al, 2007; Entezari et al, 2012; Ito et al, 2011; Kosai et al, 2008; Sharma et al, 2013; Tasaka et al, 2010; van Zoelen et al, 2008; Zhou et al, 2011d). Both RAGE and TLR4 play roles in the regulation of HMGB1-mediated inflammatory response during pneumonia (Achouiti et al, 2013; Entezari et al, 2012; Ramsgaard et al, 2011).…”

Blood biomarkers differentiating viral versus bacterial pneumonia aetiology: a literature review

“…A total of eleven studies involved CRP [14,16,17,19,20,22,23,[25][26][27][28][29]. In all the studies analysing CRP as a diagnostic marker, the average CRP level was higher in the bacterial group than viral group [14,20,22,23,[25][26][27][28][29].…”

“…This meant that before hospital admission, many patients might have had exposure to antibiotics which may have altered the level of CRP [27]. Another drawback was that only one study investigated co-infection (viral-bacterial) and concluded that CRP level did not correlate with co-infection [29].…”

Diagnostic Value of Different Biomarkers to Identify Bacterial Coinfection in Vietnamese Children with Severe Rhinovirus Pneumonia

“…20,21,[32][33][34] The optimal cutoff point for hs-CRP was 1.53 mg/dl (sensitivity 90%, specificity 56%), and the AUC for hs-CRP was 0.772, indicating this diagnostic value was valid. Although some authors were arguing that CRP is not useful in distinguishing coin-fected bacterial infections in patients with Rhinovirus community pneumonia, 26,35 other studies were confirming the ability to distinguish between viral and bacterial agents that cause pneumonia with CRP limit point > 0.8mg/dl. [36][37][38] Although controversies exist surrounding the use of the hs-CRP index to identify severe pneumonia caused by coinfection with the virus, this biomarker can still be used to support decisions about antibiotic use.…”