Researchers from Children’s Hospital of Philadelphia (CHOP) demonstrated how rapid testing of cytokine levels can help distinguish different diseases with similar symptom profiles. Nearly 30% of clinicians changed how they managed disease in children after receiving cytokine level information, showing the potential for this testing to impact clinical practice. The findings were recently published in the Journal of Allergy and Clinical Immunology.
During the COVID-19 pandemic, doctors began diagnosing patients with multisystem inflammatory syndrome in children (MIS-C), a condition that occurs weeks after infection and results from inflammation throughout the body. However, the initial symptoms – such as high fever and changes in blood pressure – are very similar to those of an acute, severe COVID-19 infection, so doctors needed to be able to distinguish between the two conditions, since each one requires a very different course of treatment.
Distinguishing between MIS-C and COVID-19 is just one example of the value of serum cytokine panels. Cytokines are signaling proteins that regulate inflammation and coordinate immune responses. Researchers and clinical laboratories have worked hard to make sure that cytokine panels can be analyzed more quickly to inform the course of care – with most results returned after 5 to 7 days – yet understanding the value of cytokines in real time, within 24 hours, as biomarkers for different diseases is a relatively new concept.
“We wanted to see what clinicians were able to do with this information if it was returned rapidly and whether results would change clinical decision making or muddy the waters and create confusion,” said senior study author Michele P. Lambert, MD, Medical Director of the Special Coagulation Laboratory and an attending physician in the Division of Hematology at CHOP. “We wanted to see potential changes included adding additional antimicrobials or an immune suppressant in response to the results in the panel.”
The study found that the diagnosis was changed or informed in 18.8% of reviewed cases and management of the patient was changed or informed in 29.8% of cases. Even in the remaining 70.2% of cases where patient care did not change, the results provided important information confirming doctors were providing a correct course of treatment.
Another key finding in the study was that specific disease states had clear cytokine patterns. For example, higher levels of interferon gamma (IFNg) and lower levels of interleukins 6 and 8 (IL-6 and IL-8) suggested a more robust inflammatory response, such as cytokine storm or familial hemophagocytic lymphohistiocystosis, a rare condition where the immune system attacks one’s own body if left untreated. However, a reverse in those levels was more indicative of bacterial or viral sepsis.
“The results of a cytokine panel could potentially save lives: supporting antibiotics or immune suppression, but only if we have the results fast enough,” Lambert said. “The evolution of our response time and our understanding of the value of these biomarkers demonstrates how important it is for clinicians and clinical laboratories to collaborate to provide the best care possible for patients.”
Gallo et al, “Serum Cytokine Panels in Pediatric Clinical Practice.” J Allergy Clin Immunol. Online September 18, 2024. DOI: 10.1016/j.jaci.2024.08.030
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Researchers from Children’s Hospital of Philadelphia (CHOP) demonstrated how rapid testing of cytokine levels can help distinguish different diseases with similar symptom profiles. Nearly 30% of clinicians changed how they managed disease in children after receiving cytokine level information, showing the potential for this testing to impact clinical practice. The findings were recently published in the Journal of Allergy and Clinical Immunology.
During the COVID-19 pandemic, doctors began diagnosing patients with multisystem inflammatory syndrome in children (MIS-C), a condition that occurs weeks after infection and results from inflammation throughout the body. However, the initial symptoms – such as high fever and changes in blood pressure – are very similar to those of an acute, severe COVID-19 infection, so doctors needed to be able to distinguish between the two conditions, since each one requires a very different course of treatment.
Distinguishing between MIS-C and COVID-19 is just one example of the value of serum cytokine panels. Cytokines are signaling proteins that regulate inflammation and coordinate immune responses. Researchers and clinical laboratories have worked hard to make sure that cytokine panels can be analyzed more quickly to inform the course of care – with most results returned after 5 to 7 days – yet understanding the value of cytokines in real time, within 24 hours, as biomarkers for different diseases is a relatively new concept.
“We wanted to see what clinicians were able to do with this information if it was returned rapidly and whether results would change clinical decision making or muddy the waters and create confusion,” said senior study author Michele P. Lambert, MD, Medical Director of the Special Coagulation Laboratory and an attending physician in the Division of Hematology at CHOP. “We wanted to see potential changes included adding additional antimicrobials or an immune suppressant in response to the results in the panel.”
The study found that the diagnosis was changed or informed in 18.8% of reviewed cases and management of the patient was changed or informed in 29.8% of cases. Even in the remaining 70.2% of cases where patient care did not change, the results provided important information confirming doctors were providing a correct course of treatment.
Another key finding in the study was that specific disease states had clear cytokine patterns. For example, higher levels of interferon gamma (IFNg) and lower levels of interleukins 6 and 8 (IL-6 and IL-8) suggested a more robust inflammatory response, such as cytokine storm or familial hemophagocytic lymphohistiocystosis, a rare condition where the immune system attacks one’s own body if left untreated. However, a reverse in those levels was more indicative of bacterial or viral sepsis.
“The results of a cytokine panel could potentially save lives: supporting antibiotics or immune suppression, but only if we have the results fast enough,” Lambert said. “The evolution of our response time and our understanding of the value of these biomarkers demonstrates how important it is for clinicians and clinical laboratories to collaborate to provide the best care possible for patients.”
Gallo et al, “Serum Cytokine Panels in Pediatric Clinical Practice.” J Allergy Clin Immunol. Online September 18, 2024. DOI: 10.1016/j.jaci.2024.08.030
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