BACKGROUND Cytokines are soluble signaling proteins that regulate inflammation and coordinate immune responses. Serum cytokine panels are increasingly used in medical practice, yet our understanding of cytokines as biomarkers for disease remains limited. OBJECTIVE We sought to analyze real-world single-center use of a multiplexed cytokine panel, correlate its results with diagnosis and severity, and explore its use in pediatric practice. METHODS A multiplexed cytokine panel, able to return same-day results, was implemented in April 2020 at the Children's Hospital of Philadelphia (Philadelphia, Pa) and its performance was validated for clinical use. Coded patient data were collected using the REDCap database, and correlations between cytokine levels and outcomes of interest were analyzed retrospectively. RESULTS Cytokine levels correlate with acuity of care, with patients admitted to the pediatric intensive care unit having the highest cytokine values. Patients with familial hemophagocytic lymphohistiocytosis (fHLH) showed prominent peaks in IFN-γ, IL-10, and TNF, whereas patients with sepsis exhibited high IL-6 and IL-8 with relatively modest IFN-γ. Cytokine release syndrome (CRS) after chimeric antigen receptor T-cell therapy often demonstrated pan-panel positivity at peak levels, with a similar pattern as that of fHLH. A ratio of [IFN-γ] + [IL-10]/[IL-6] + [IL-8] levels was able to distinguish fHLH and CRS from severe sepsis. CONCLUSIONS Cytokine levels correlate with severity of illness and can help differentiate between syndromes that present similarly, including fHLH and CRS compared with sepsis. Cytokine panels can be used as biomarkers to inform diagnosis and management decisions, but significant work remains to dissect complex clinical patterns of disease.

中文翻译：

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儿科临床实践中的血清细胞因子面板。


背景 细胞因子是调节炎症和协调免疫反应的可溶性信号蛋白。血清细胞因子面板越来越多地用于医疗实践，但我们对细胞因子作为疾病生物标志物的理解仍然有限。目的 我们试图分析多重细胞因子面板的真实世界单中心使用，将其结果与诊断和严重程度相关联，并探索其在儿科实践中的应用。方法 2020 年 4 月在费城儿童医院（宾夕法尼亚州费城）实施了能够当天返回结果的多重细胞因子面板，其性能已验证可用于临床。使用 REDCap 数据库收集编码的患者数据，并回顾性分析细胞因子水平与感兴趣结果之间的相关性。结果 细胞因子水平与护理敏锐度相关，入住儿科重症监护病房的患者细胞因子值最高。家族性噬血细胞性淋巴组织细胞增生症 （fHLH） 患者在 IFN-γ 、 IL-10 和 TNF 中表现出显著的峰值，而脓毒症患者表现出较高的 IL-6 和 IL-8 水平，而 IFN-γ 相对较温。嵌合抗原受体 T 细胞治疗后的细胞因子释放综合征 （CRS） 通常在峰值水平上表现出泛面板阳性，与 fHLH 的模式相似。[IFN-γ] + [IL-10] / [IL-6] + [IL-8] 水平的比率能够区分 fHLH 和 CRS 与重度败血症。结论 细胞因子水平与疾病严重程度相关，有助于区分表现相似的综合征，包括与脓毒症相比的 fHLH 和 CRS。细胞因子面板可用作生物标志物，为诊断和管理决策提供信息，但剖析复杂的疾病临床模式仍有大量工作要做。