Diagnostic Value of Serum CRP, PCT and IL-6 in Children with Nephrotic Syndrome Complicated by Infection: a Single Center Retrospective Study

Overview

Journal Pediatr Res

Specialties Biology
Pediatrics

Date 2023 Sep 29

PMID 37773440

Authors

Wanyu Jia

Wenjie Dou

Huiqin Zeng

Qin Wang

Peipei Shi

Jing Liu

Zhen Liu

Jin Zhang

Jianjiang Zhang

Affiliations

Soon will be listed here.

Abstract

Objective: The purpose was to look into the diagnostic value of serum CRP, PCT and IL-6 in children with nephrotic syndrome co-infection.

Methods: One hundred and forty-nine children with nephrotic syndrome who met the inclusion and exclusion criteria were included in this study. The children were divided into three groups: bacterial infection group, non-bacterial infection group, and non-infection group. The diagnostic value was analyzed and compared using the ROC curve.

Results: There was no statistically significant difference in the Leukocyte counts among three groups. The mean results of serum CRP, PCT and IL-6 were significantly higher in the bacterial infection group compared to those in the non-infection group (p < 0.05). AUC of CRP, PCT, IL-6 in bacterial infection were 0.791, 0.859, 0.783. The following combinations CRP + PCT + IL-6, IL-6 + PCT, CRP + PCT significantly increased the efficiency of bacterial infection diagnosis, the AUCs were 0.881, 0.884, and 0.884, respectively. AUC of PCT in non-bacterial infection was 0.663. The combinations of these three clinical indicators performed no better than PCT in ROC analysis.

Conclusion: Normal CRP or IL-6 levels do not rule out the diagnosis of bacterial infection in children on long-term glucocorticoid therapy. The appropriate combination of two or three indicators can improve the diagnostic value.

Impact: This study evaluated the diagnostic value of the serum concentrations of CRP, PCT and IL-6 and assessed whether the value of their combined application is better than when used alone for diagnosing primary nephrotic syndrome complicated by infection. The elevation in leukocyte count cannot be used to diagnose children with nephrotic syndromes on long-term glucocorticoid treatment who have bacterial infections. Normal CRP or IL-6 levels do not rule out the diagnosis of bacterial infection in children on long-term glucocorticoid therapy. The appropriate combination of two or three indicators can improve diagnostic value, sensitivity, and specificity.

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References

Kumar M, Ghunawat J, Saikia D, Manchanda V . Incidence and risk factors for major infections in hospitalized children with nephrotic syndrome. J Bras Nefrol. 2019; 41(4):526-533. PMC: 6979567. DOI: 10.1590/2175-8239-JBN-2019-0001. View

Sorkhi H, Riahi S, Ebrahimpour S, Shaikh N, Rostami A . Urinary tract infection in children with nephrotic syndrome: A systematic review and meta-analysis. Microb Pathog. 2019; 137:103718. DOI: 10.1016/j.micpath.2019.103718. View

Cain D, Cidlowski J . Immune regulation by glucocorticoids. Nat Rev Immunol. 2017; 17(4):233-247. PMC: 9761406. DOI: 10.1038/nri.2017.1. View

Velthove K, Leufkens H, Souverein P, Schweizer R, Bracke M, van Solinge W . Effects of glucocorticoids on the neutrophil count: a cohort study among hospitalized patients. Pulm Pharmacol Ther. 2009; 23(2):129-34. DOI: 10.1016/j.pupt.2009.10.006. View

Kiuchi Z, Nishibori Y, Kutsuna S, Kotani M, Hada I, Kimura T . GLCCI1 is a novel protector against glucocorticoid-induced apoptosis in T cells. FASEB J. 2019; 33(6):7387-7402. DOI: 10.1096/fj.201800344RR. View

Prenek L, Boldizsar F, Kugyelka R, Ugor E, Berta G, Nemeth P . The regulation of the mitochondrial apoptotic pathway by glucocorticoid receptor in collaboration with Bcl-2 family proteins in developing T cells. Apoptosis. 2016; 22(2):239-253. PMC: 5306359. DOI: 10.1007/s10495-016-1320-8. View

Hu L, Shi Q, Shi M, Liu R, Wang C . Diagnostic Value of PCT and CRP for Detecting Serious Bacterial Infections in Patients With Fever of Unknown Origin: A Systematic Review and Meta-analysis. Appl Immunohistochem Mol Morphol. 2017; 25(8):e61-e69. DOI: 10.1097/PAI.0000000000000552. View

Shao W, Yu D, Zhang W, Wang X . Clinical Significance of Interleukin-6 in the Diagnosis of Sepsis and Discriminating Sepsis Induced by Gram-negative Bacteria. Pediatr Infect Dis J. 2018; 37(8):801-805. DOI: 10.1097/INF.0000000000001904. View

Zhou J, Shi F, Xun W . Leptin, hs-CRP, IL-18 and urinary protein before and after treatment of children with nephrotic syndrome. Exp Ther Med. 2018; 15(5):4426-4430. PMC: 5920766. DOI: 10.3892/etm.2018.5923. View

10.

Jekarl D, Lee S, Lee J, Park Y, Kim Y, Park J . Procalcitonin as a diagnostic marker and IL-6 as a prognostic marker for sepsis. Diagn Microbiol Infect Dis. 2013; 75(4):342-7. DOI: 10.1016/j.diagmicrobio.2012.12.011. View

11.

Xu X, Luo Z, Xia T, Song H, Yang S, Xu W . Comparison of interleukin-6, interleukin-10, procalcitonin and C-reactive protein in identifying high-risk febrile illness in pediatric cancer patients: A prospective observational study. Cytokine. 2019; 116:1-6. DOI: 10.1016/j.cyto.2019.01.004. View

12.

Iapichino G, Marzorati S, Umbrello M, Baccalini R, Barassi A, Cainarca M . Daily monitoring of biomarkers of sepsis in complicated long-term ICU-patients: can it support treatment decisions?. Minerva Anestesiol. 2010; 76(10):814-23. View

13.

Jekarl D, Kim J, Lee S, Kim M, Kim Y, Han K . Diagnosis and evaluation of severity of sepsis via the use of biomarkers and profiles of 13 cytokines: a multiplex analysis. Clin Chem Lab Med. 2014; 53(4):575-81. DOI: 10.1515/cclm-2014-0607. View

14.

Gao L, Liu X, Zhang D, Xu F, Chen Q, Hong Y . Early diagnosis of bacterial infection in patients with septicopyemia by laboratory analysis of PCT, CRP and IL-6. Exp Ther Med. 2017; 13(6):3479-3483. PMC: 5450606. DOI: 10.3892/etm.2017.4417. View

15.

Lee C, Kwa A, Apisarnthanarak A, Feng J, Gluck E, Ito A . Procalcitonin (PCT)-guided antibiotic stewardship in Asia-Pacific countries: adaptation based on an expert consensus meeting. Clin Chem Lab Med. 2020; 58(12):1983-1991. DOI: 10.1515/cclm-2019-1122. View

16.

Ma L, Zhang H, Yin Y, Guo W, Ma Y, Wang Y . Role of interleukin-6 to differentiate sepsis from non-infectious systemic inflammatory response syndrome. Cytokine. 2016; 88:126-135. DOI: 10.1016/j.cyto.2016.08.033. View

17.

Lai L, Lai Y, Wang H, Peng L, Zhou N, Tian Y . Diagnostic Accuracy of Procalcitonin Compared to C-Reactive Protein and Interleukin 6 in Recognizing Gram-Negative Bloodstream Infection: A Meta-Analytic Study. Dis Markers. 2020; 2020:4873074. PMC: 7008263. DOI: 10.1155/2020/4873074. View

18.

Zhu S, Zeng C, Zou Y, Hu Y, Tang C, Liu C . The Clinical Diagnostic Values of SAA, PCT, CRP, and IL-6 in Children with Bacterial, Viral, or Co-Infections. Int J Gen Med. 2021; 14:7107-7113. PMC: 8554317. DOI: 10.2147/IJGM.S327958. View

19.

Dittrich A, Khouri C, Sackett S, Ehlting C, Bohmer O, Albrecht U . Glucocorticoids increase interleukin-6-dependent gene induction by interfering with the expression of the suppressor of cytokine signaling 3 feedback inhibitor. Hepatology. 2011; 55(1):256-66. DOI: 10.1002/hep.24655. View

20.

Ebisawa K, Shimura A, Honda A, Masamoto Y, Nakahara F, Kurokawa M . Hemoglobin and C-reactive protein levels as predictive factors for long-term successful glucocorticoid treatment for multicentric Castleman's disease. Leuk Lymphoma. 2020; 62(3):614-619. DOI: 10.1080/10428194.2020.1834094. View