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Changes of selected systemic cytokines in severe pediatric lung disease


Authors: L. Šašek;  J. Fremuth;  K. Pizingerová;  J. Kobr
Authors‘ workplace: Dětská klinika, Univerzita Karlova v Praze, Lékařská fakulta a Fakultní nemocnice v Plzni přednosta prof. MUDr. J. Sýkora, Ph. D.
Published in: Čes-slov Pediat 2016; 71 (5-6): 251-259.
Category: Original Papers

Overview

Background:
Severe lung diseases leading to respiratory failure are among the most frequent causes of critical conditions in childhood. Pulmonary injury leads to a systemic response of the organism and the response rate should be at the level of cytokines proportional to the degree of lung injury. The study aims to monitor systemic inflammatory response dependence on the degree of pulmonary injury using selected cytokines in pediatric patients.

Methods:
Thirty-two patients with severe pulmonary injury and Lung Injury Score >1.0 leading to respiratory failure were included. Mean age of enrolled patients was 39.5 months, weight 14.2 kg. Twenty-nine patients had primary lung disease ALI//ARDS based on aspiration, pulmonary infection, autoimmune process, pulmonary contusion, or pulmonary arterial hypertension, 3 patients secondary ARDS in septic shock and multiorgan failure. Patients were mechanically invasively ventilated. Patients were monitored during the study for 48 hours, laboratory sampling was performed in the 1st, 12th, 24th and 48th hour of experiment.

Results:
From observed markers matrix metalloproteinase MMP-9 was extremely high already in 1st hour with subsequent significant decrease. There was counter-regulatory increase of metalloproteinases inhibitor TIMP-1 at 12th hour related to initially high MMP-9. Expression of adhesion molecules was present already at the beginning of observation. ICAM-1 during the study descend insignificantly. VCAM-1 changes over time were statistically very significant with initial high levels and further decreasing the expression.

Conclusions:
On the set of critically ill children with severe pulmonary impairment were detected early systemic cytokine response with signs of endothelial activation. Changes in the spectrum of cytokines in severe lung disease may indicate the influence of other organ systems, not only on the level of blood gases exchange alterations resulting in tissue hypoxia.

Key words:
ALI, ARDS, adhesion molecules, metalloproteinases


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Neonatology Paediatrics General practitioner for children and adolescents
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