Liver dysfunction in children with community-acquired pneumonia: the role of infectious and inflammatory markers

Abstract

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. Key words: cytokines, C-reactive protein, fibrinogen, alanine aminotransferase, aspartate aminotransferase, liver, community-acquired pneumonia, children, early age.