Association between interleukin-8 and severity of dengue shock syndrome in children
Abstract: Dengue hemorrhagic
fever (DHF) remains a major health problem in tropical countries. The case
fatality rate (CFR) can be reduced from 45% to <1%, if dengue shock syndrome
(DSS) is treated early and adequately. Early biomarkers for DSS outcomes in
children are needed. Interleukin-8 (IL-8) might be one of the molecule, as it
plays a role in the pathophysiology of DHF in children.
Objective To assess IL-8 levels in pediatric DHF patients at various
stages of illness severity and to determine the correlation between serum IL-8
concentration on admission and DSS outcomes in children.
Methods A prospective cohort study was done in children with DSS who were
admitted to the Pediatrics Department of Kandou Hospital, Manado. We measured
subjects’ serum IL-8 levels at the time of DSS diagnosis and followed-up
subjects until there was improvement or deterioration. An association between
IL-8 and DSS outcome was analyzed using univariable logistic regression test.
An ROC curve and Chi-square test were used to analyze the prognostic value of
serum IL-8 levels. Statistical significance was considered to be a P value of
<0.05 (power 80, β=0.20)..
Results Fifty-eight children with DSS were included in this study.
Twenty-seven subjects had clinical deterioration (to recurrent shock, prolonged
shock or died). There was a significant association between elevated IL-8
levels and clinical deterioration in DSS (OR 116.7; 95%CI 18.0 to 756.0;
P=0.0001). The ROC curve revealed an IL-8 cut-off level of 194.9 pg/mL, AUC
0.982, with sensitivity 89.3%, specificity 93.3%, positive predictive value
(PPV) 92.6%, negative predictive value (NPV) 90.3%.
Conclusion There is an association between elevated early serum IL-8
level and a DSS deterioration. Further prognostic studies are needed to confirm
the predictive ability of serum IL-8 level on DSS deterioration in children.
Author: Suryadi N. N. Tatura,
Dasril Daud, Irawan Yusuf, Sitti Wahyuni, Janno B. Bernadus
Journal Code: jpkedokterangg160031
