Abstract Background Mechanisms influencing severity of acute lower respiratory infection (ALRI) in children are not established. We aimed to assess the role of inflammatory markers and respiratory viruses in ALRI severity. Methods Concentrations of interleukin(IL)-33, soluble suppression of tumorigenicity (sST)2, IL-1ß, tumor necrosis factor α, IL-4, IL-6 and IL- 8 and types of respiratory viruses were evaluated in children at the first and fifth days after hospital admission. Disease severity was defined as need for mechanical ventilation. Results Seventy-nine children <5 years-old were included; 33(41.8%) received mechanical ventilation. No associations between virus type, viral load or co-detections and severity of disease were observed. Detection of IL-33 and sST2 in nasopharyngeal aspirates (NPA) on admission were associated with higher risk for mechanical ventilation (RR = 2.89 and RR = 4.57, respectively). IL-6 and IL-8 concentrations were higher on Day 5 in mechanically ventilated children. IL-6 NPA concentrations decreased from Day 1 to Day 5 in children who did not receive mechanical ventilation. Increase in sST2 NPA concentrations from Day 1 to Day 5 was associated with longer hospital length of stay (p < 0.01). Conclusions An exacerbated local activation of the IL-33/ST2 axis and persistently high sST2 concentrations over time were associated with severity of viral ALRI in children.

中文翻译：

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IL-33 和 ST2 作为病毒性急性下呼吸道感染儿童疾病严重程度的预测因子

摘要 背景 影响儿童急性下呼吸道感染 (ALRI) 严重程度的机制尚未确定。我们旨在评估炎症标志物和呼吸道病毒在 ALRI 严重程度中的作用。方法 评估儿童白细胞介素（IL）-33、致瘤性可溶性抑制（sST）2、IL-1β、肿瘤坏死因子α、IL-4、IL-6和IL-8的浓度以及呼吸道病毒的类型。入院后第一天和第五天。疾病严重程度定义为需要机械通气。结果<5岁儿童79例；33（41.8%）人接受机械通气。没有观察到病毒类型、病毒载量或共同检测与疾病严重程度之间的关联。入院时鼻咽抽吸物 (NPA) 中检测到 IL-33 和 sST2 与较高的机械通气风险相关（分别为 RR = 2.89 和 RR = 4.57）。机械通气儿童的 IL-6 和 IL-8 浓度在第 5 天较高。在未接受机械通气的儿童中，IL-6 NPA 浓度从第 1 天到第 5 天下降。从第 1 天到第 5 天 sST2 NPA 浓度的增加与更长的住院时间有关（p < 0.01）。结论 IL-33/ST2 轴局部激活加剧和 sST2 浓度随时间持续升高与儿童病毒性 ALRI 的严重程度相关。在未接受机械通气的儿童中，IL-6 NPA 浓度从第 1 天到第 5 天下降。从第 1 天到第 5 天 sST2 NPA 浓度的增加与更长的住院时间有关（p < 0.01）。结论 IL-33/ST2 轴局部激活加剧和 sST2 浓度随时间持续升高与儿童病毒性 ALRI 的严重程度相关。在未接受机械通气的儿童中，IL-6 NPA 浓度从第 1 天到第 5 天下降。从第 1 天到第 5 天 sST2 NPA 浓度的增加与更长的住院时间有关（p < 0.01）。结论 IL-33/ST2 轴局部激活加剧和 sST2 浓度随时间持续升高与儿童病毒性 ALRI 的严重程度相关。