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Prognostic serum tumor necrosis factor-alpha in paediatric patients with sepsis.

OBJECTIVE
To study the association of tumor necrosis factor-alpha (TNF-alpha) in paediatric patients with different etiological agents and levels of sepsis.


METHODOLOGY
Seventy-nine patients with sepsis were studied. Blood cultures, along with other relevant specimens, were processed for bacterial and fungal etiology. TNF-alpha was detected by enzyme immunoassay.


RESULTS
In total, 42 (53.2%) of the patients had a microbiologically documented cause for sepsis. Of the gram-negative bacilli, Escherichia coli was the most common isolate followed by Klebsiella pneumoniae. Enterobacter spp. Serratia marscecens as well as Citrobacter koseri. Streptococcus pneumoniae and Staphylococcus aureus predominated among the gram-positive cocci. Patients with a positive culture had significantly higher TNF-alpha levels than patients with a negative culture (70 pg/ml vs. 33 pg/ml p = 0.01). Patients with a pure gram-negative infection had significantly higher TNF-alpha levels than those with pure gram-positive infection (83 pg/ml vs.52 pg/ml). The geometric mean TNF-alpha concentrations in patients with severe sepsis and those with late septic shock were 47 pg/ml (range 5-2720) and 59 pg/ml (range 5-3310) respectively.


CONCLUSION
TNF-alpha was significantly raised in culture-positive cases in general and in gram-negative infections in particular. It can be used as a surrogate marker of sepsis and aggressive treatment initiated in patients with elevated levels of TNF alpha.