Serum tumor necrosis factor alpha and C-reactive protein in pediatric patients with sepsis and its correlation with microbiologic findings

Abstract

Objective: To study the association of tumor necrosis factor-a (TNF-a) and C--reactive protein (CRP) with microbiologically documented cases of sepsis versus clinically documented cases of sepsis.

Materials and methods: Seventy nine pediatric patients with sepsis were studied. Relevant specimens were processed for bacterial or fungal etiology. TNF-a was detected by enzyme immunoassay and CRP was detected by latex agglutination. Thirty healthy cases were included in the study to establish baseline TNF-alpha levels.

Results: Forty two (53.2%) patients had a microbiologically documented sepsis. Among Gram negative bacilli Escherichia coli was the most common isolate followed by Klebsiella spp. Staphylococcus aureus and Streptococcus pneumoniae 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). Further, pure gram negative infection correlated with significantly higher TNF-alpha levels than pure (P < 0.01) gram positive infection. The CRP values did not highlight these differences significantly.

Conclusions: TNF-alpha level was significantly raised in patients with sepsis. TNF-a levels were raised significantly in culture positive cases in general and in Gram negative infections in particular. Serum TNF-alpha was a more sensitive marker for different categories of sepsis compared to CRP and microbiology culture.