Liver dysfunction in children with community-acquired pneumonia: the role of infectious and inflammatory markers
DOI:
https://doi.org/10.15574/SP.2022.122.32Keywords:
cytokines, C-reactive protein, fibrinogen, alanine aminotransferase, aspartate aminotransferase, liver, community-acquired pneumonia, children, early ageAbstract
Today, pneumonia remains the leading cause of infant mortality and morbidity worldwide. Pneumonia increases inflammatory processes, accompanied by the activation of inflammatory mediators, and can provoke significant metabolic disorders in the body.
Purpose - to determine liver dysfunction in young children with community-acquired pneumonia based on the study of markers of infectious-inflammatory process.
Materials and methods. The results of clinical and laboratory examination of 338 children aged 1 month to 3 years with community-acquired pneumonia were analyzed. The children were hospitalized in the Infectious Diseases Boxed Department for Young Children of the Vinnytsia Regional Children’s Clinical Hospital. Verification of the diagnosis was made using the recommendations of the British Thoracic Society. All patients had pneumonia of varying severity, depending on which they were divided into two groups: group I - 129 children who were diagnosed with community-acquired pneumonia of moderate severity; group II - 209 patients with severe pneumonia. Comparison group - 40 healthy children.
Results. Markers of infectious-inflammatory process were studied to determine the levels of pro-inflammatory cytokines - interleukin (IL-1, IL-6) and proteins of the acute phase of inflammation - C-reactive protein (CRP) and fibrinogen in the serum of young children with outpatients. Aminotransferase hyperenzymemia is closely correlated with the activity of the infectious-inflammatory process, which indicates a positive correlation between the level of IL-1 and ALT (rxy=+0.047) and AST (rxy=+0.111). At the same time, there is a negative correlation between the levels of IL-1, CRP and the activity of aminotransferases in blood plasma.
Conclusions. It was found that the course of community-acquired pneumonia is accompanied by an increase in the serum of children with concentrations of IL-1 and IL-6 in parallel with the severity of the disease. The synthesis of pro-inflammatory cytokines stimulates the production of acute CRP, but reduces the concentration of fibrinogen in the blood of sick children. The identified links between the content of the studied cytokines at the systemic level and multidirectional changes in the acute phase of inflammation indicate a violation of the liver, where proteins are synthesized.
The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of the participating institution. The informed consent of the patient was obtained for conducting the studies.
No conflict of interests was declared by the authors.
References
Cai SY, Boyer JL. (2017). The role of inflammation in the mechanisms of bile acid-induced liver damage. Dig Dis. 35 (3): 232-234. https://doi.org/10.1159/000450916; PMid:28249287 PMCid:PMC6051694
Dean P, Florin TA. (2018). Factors associated with pneumonia severity in children: a systematic review. J Pediatric Infect Dis Soc. 7 (4): 323-334. https://doi.org/10.1093/jpids/piy046; PMid:29850828 PMCid:PMC6454831
Derzhavnyi ekspertnyi tsentr Ministerstva okhorony zdorovia Ukrainy HS «Ukrainska Akademiia Pediatrychnykh spetsialnostei» Medychna merezha «Dobrobut». (2021). Pozalikarniana pnevmoniia v ditei vikom vid 1 misiatsia. Klinichna nastanova, zasnovana na dokazakh. Suchasna pediatriia. Ukraina. 1 (113): 82-111. URL: https://med-expert.com.ua/journals/wp-content/uploads/2021/03/13.pdf.
Dinarello CA. (2018). Overview of the IL-1 family in innate inflammation and acquired immunity. Immunol Rev. 281 (1): 8-27. https://doi.org/10.1111/imr.12621; PMid:29247995 PMCid:PMC5756628
Dinarello CA. (2019). The IL-1 family of cytokines and receptors in rheumatic diseases. Nat Rev Rheumatol. 15 (10): 612-632. https://doi.org/10.1038/s41584-019-0277-8; PMid:31515542
Ewid M, Sherif H, Allihimy AS, Alharbi SA, Aldrewesh DA, Alkuraydis SA, Abazid R. (2020). AST/ALT ratio predicts the functional severity of chronic heart failure with reduced left ventricular ejection fraction. BMC Res Notes. 13 (1): 178. https://doi.org/10.1186/s13104-020-05031-3; PMid:32209113 PMCid:PMC7092498
Leung AKC, Wong AHC, Hon KL. (2018). Community-acquired pneumonia in children. Recent Pat Inflamm Allergy Drug Discov. 12 (2): 136-144. https://doi.org/10.2174/1872213X12666180621163821; PMid:29932038
Lyons PG, Kollef MH. (2018). Prevention of hospital-acquired pneumonia. Curr Opin Crit Care. 24 (5): 370-378. https://doi.org/10.1097/MCC.0000000000000523; PMid:30015635
McMaster WG, Kirabo A, Madhur MS, Harrison DG. (2015). Inflammation, immunity, and hypertensive end-organ damage. Circ Res. 116 (6): 1022-1033. https://doi.org/10.1161/CIRCRESAHA.116.303697; PMid:25767287 PMCid:PMC4535695
Mizgerd JP. (2017). Pathogenesis of severe pneumonia: advances and knowledge gaps. Curr Opin Pulm Med. 23 (3): 193-197. https://doi.org/10.1097/MCP.0000000000000365; PMid:28221171 PMCid:PMC5492380
Olteanu S, Kandel-Kfir M, Shaish A, Almog T, Shemesh S, Barshack I, Apte RN, Harats D, Kamari Y. (2014). Lack of interleukin-1alpha in Kupffer cells attenuates liver inflammation and expression of inflammatory cytokines in hypercholesterolaemic mice. Dig Liver Dis. 46 (5): 433-439. https://doi.org/10.1016/j.dld.2014.01.156; PMid:24582082
Polepalle T, Moogala S, Boggarapu S, Pesala DS, Palagi FB. (2015). Acute phase proteins and their role in periodontitis: a review. J Clin Diagn Res. 9 (11): ZE01-5. https://doi.org/10.7860/JCDR/2015/15692.6728; PMid:26674303 PMCid:PMC4668538
Rajab IM, Hart PC, Potempa LA. (2020). How C-reactive protein structural isoforms with distinctive bioactivities affect disease progression. Front Immunol. 11: 2126. https://doi.org/10.3389/fimmu.2020.02126; PMid:33013897 PMCid:PMC7511658
Reitman S, Frankel S. (1957). A colorimetric method for the determination of serum glutamic oxalacetic and glutamic pyruvic transaminases. Am J Clin Pathol. 28 (1): 56-63. https://doi.org/10.1093/ajcp/28.1.56; PMid:13458125
Ridker PM, Lüscher TF. (2014). Anti-inflammatory therapies for cardiovascular disease. Eur Heart J. 35 (27): 1782-1791. https://doi.org/10.1093/eurheartj/ehu203; PMid:24864079 PMCid:PMC4155455
Robinson MW, Harmon C, O'Farrelly C. (2016). Liver immunology and its role in inflammation and homeostasis. Cell Mol Immunol. 13 (3): 267-276. https://doi.org/10.1038/cmi.2016.3; PMid:27063467 PMCid:PMC4856809
Rudd JM, Pulavendran S, Ashar HK, Ritchey JW, Snider TA, Malayer JR, Marie M, Chow VTK, Narasaraju T. (2019). Neutrophils induce a novel chemokine receptors repertoire during influenza pneumonia. Front Cell Infect Microbiol. 9: 108. https://doi.org/10.3389/fcimb.2019.00108; PMid:31041196 PMCid:PMC6476945
Schuijt TJ, Lankelma JM, Scicluna BP, de Sousa e Melo F, Roelofs JJ, de Boer JD, Hoogendijk AJ, de Beer R, de Vos A, Belzer C, de Vos WM, van der Poll T, Wiersinga WJ. (2016). The gut microbiota plays a protective role in the host defence against pneumococcal pneumonia. Gut. 65 (4): 575-583. https://doi.org/10.1136/gutjnl-2015-309728; PMid:26511795 PMCid:PMC4819612
Shiba D, Hifumi T, Watanabe Y, Shimizu M, Isokawa S, Toya N, Iwasaki T, Otani N, Ishimatsu S. (2020). Association between inflammation in acute phase and early onset pneumonia in patients with out-of-hospital cardiac arrest treated with extracorporeal cardiopulmonary resuscitation. Acute Med Surg. 7 (1): e610. https://doi.org/10.1002/ams2.610; PMid:33318804 PMCid:PMC7726615
Tanaka T, Narazaki M, Kishimoto T. (2014). IL-6 in inflammation, immunity, and disease. Cold Spring Harb Perspect Biol. 6 (10): a016295. https://doi.org/10.1101/cshperspect.a016295; PMid:25190079 PMCid:PMC4176007
Wang H, Luo H, Wan X, Fu X, Mao Q, Xiang X, Zhou Y, He W, Zhang J, Guo Y, Tan W, Deng G. (2020). TNF-alpha/IFN-gamma profile of HBV-specific CD4 T cells is associated with liver damage and viral clearance in chronic HBV infection. J Hepatol. 72 (1): 45-56. https://doi.org/10.1016/j.jhep.2019.08.024; PMid:31499130
Downloads
Published
Issue
Section
License
Copyright (c) 2022 Modern pediatrics. Ukraine
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The policy of the Journal “MODERN PEDIATRICS. UKRAINE” is compatible with the vast majority of funders' of open access and self-archiving policies. The journal provides immediate open access route being convinced that everyone – not only scientists - can benefit from research results, and publishes articles exclusively under open access distribution, with a Creative Commons Attribution-Noncommercial 4.0 international license (СС BY-NC).
Authors transfer the copyright to the Journal “MODERN PEDIATRICS. UKRAINE” when the manuscript is accepted for publication. Authors declare that this manuscript has not been published nor is under simultaneous consideration for publication elsewhere. After publication, the articles become freely available on-line to the public.
Readers have the right to use, distribute, and reproduce articles in any medium, provided the articles and the journal are properly cited.
The use of published materials for commercial purposes is strongly prohibited.
