Serum Interleukin-6 levels in children with sepsis and septic shock

ABSTRACT

Sepsis and multiorgan failure syndromes [MOFS] are common causes of morbidity and mortality in pediatric intensive care units [PICU] and accurate diagnosis and assessment of severity remain among the greatest challenges facing pediatric intensivists. The aim of this prospective observational study is to examine the behavior of interleukin-6 [IL-6] and verify whether it can be used to assess severity of illness in children with sepsis-related syndromes. Forty two children with sepsis and septic shock aged between 2 and 122 months [median age 9 months], were prospectively enrolled from Jan 2007 to Feb 2008. Children were divided into two groups; sepsis [group 1; n = 19] and septic shock/MOFS [group 2; n = 23] groups. IL-6 was measured at admission [IL-6, Zero] and 24 hours post admission [IL-6, 24]. Twenty healthy children of matching age and sex were enrolled as a control group. IL-6, Zero levels in patients were higher than the control [p < .001]. Children in group 1 had lower IL-6 levels compared to group 2 both on admission [median levels 96.5 and 287.6 pg/ml respectively, p .005] and after 24 hours [median levels 70.3 and 188.2 pg/ml respectively, p .037]. There was a more pronounced decrease of IL-6, 24 in group 2 compared to group 1. IL-6, Zero levels showed a positive correlation with PRISM score in group 2 but not in group 1[cc .748 and .214; p <.001 and .378 respectively]. IL-6 levels were higher in non-survivors in both groups without statistical significance. Moreover, in group 1, IL-6, Zero levels were higher in those who went to develop septic shock/MOFS compared to those who did not [median values 215.4 and 65.3 respectively p .017] We conclude that IL-6 is a helpful tool to support early diagnosis of pediatric sepsis, is a marker of disease severity on admission especially in the more severely ill, and is a possible predictor of disease course