To explore the characteristics and value for predicting prognosis of cytokines in septic children with or without neutropenia.

Totally 138 septic children were divided into the neutropenia and non-neutropenia groups according to absolute neutropenic count. Septic children were divided into the shock and non-shock groups according to circulation function and organ perfusion. The levels of C-reactive protein, procalcitonin, cytokines, PRISM-Ⅲ and clinical outcomes were analyzed between the relative groups.

(1) Totally 138 septic children were recruited, 64 with neutropenia and 74 without neutropenia. The level of PRISM-Ⅲ of the neutropenia group was significantly higher than that of the non-neutropenia group (P=0.048).Mortality showed no significant difference between the two groups, but hospital stay in the neutropenia group was longer than that in the non-neutropenia group. The levels of C-reactive protein, IL-6, and IL-10 ihe neutropenia group were significantly higher than those of the non-neutropenia group (P=0.001; P=0.001; P=0.032). The level of TNF-α in the neutropenia group was significantly lower than that of the non-neutropenia group (P=0.032). (2)Among the 64 septic children with neutropenia, 23 were combined with shock. The PRISM-Ⅲ level of the shock group was significantly higher than that of the non-shock group (P=0.001). The mortality of the shock group (43.5%, 10/23) was significantly higher than the non-shock group (2.4%, 1/41) (P=0.001). C-reactive protein, procalcitonin, IL-6, IL-10 and TNF-α in the shock group elevated obviously than those in the non-shock group (P=0.001; P=0.001; P=0.001; P=0.005; P=0.019). The area under receiver operating characteristic curve was 0.8 for IL-6 (cut-off value 315.38 pg/mL), 0.8 for IL-10 (cut-off value 45.18 pg/mL), and 0.85 for TNF-α (cut-off value 1.95 pg/mL). (3) Among the 74 septic children without neutropenia, 19 were combined with shock. The PRISM-Ⅲ level of the shock group was significantly higher than that of the non-shock group (P=0.022).There was no significant difference of mortality between the two groups (P=0.3). IL-10 level in the shock group elevated obviously than that in the non-shock group (P=0.015).(4) Among the 42 children with sepsis shock, 23 were combined with neutropenia. The PRISM-Ⅲ level of the neutropenia group was significantly higher than that of the non-neutropenia group (P=0.005). There was no significant difference of mortality between the two groups (P=0.29). The levels of C-reactive protein, procalcitonin, IL-6 and IL-10 in the neutropenia group were significantly higher than those in the non-neutropenia group (P=0.001; P=0.001; P=0.001; P=0.035). There was no difference of TNF-α level between the two groups.(5) Among the 96 children without sepsis shock, 41 were combined with neutropenia. No difference of PRISM-Ⅲ level was observed between the neutropenia and non-neutropenia groups. The mortality of the neutropenia group was significantly lower than that in the non-neutropenia group (2.4% vs 20%, P=0.02). The levels of C-reactive protein and IL-6 in the neutropenia group were significantly higher than those in the non-neutropenia group (P=0.005; P=0.033). The TNF-α level was significantly lower than that in the non-neutropenia group (P=0.007).

Compared to children without neutropenia, septic children combined with neutropenia have longer hospital stay, and septic shock children combined with neutropenia have higher mortality, and levels of IL-6, IL-10 and TNF-α were also significantly increased. The levels of IL-6, IL-10 and TNF-α can help to predict prognosis of children with sepsis.

Sepsis; Shock; Septic shock; Neutropenia; Non- neutropenia; Cytokine; Children; Prognosis