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

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- levels. Results: Forty two (53.2%) patients had a microbiologically documented sepsis. Among Gram negative bacilli Escherichia coli w s the most common isolate followed by Klebsiella spp. Staphyloccus aureus and Streptococcus pneumoniae predominated among the Gram positive cocci. Patients with a positive culture had significantly higher TNF- levels than patients with a negative culture (70pg/ml vs. 33 pg/ml P < 0.01). Further, pure gram negative infection correlated with significantly higher TNF- levels than pure (P < 0.01) gram positive infection. The CRP values did not highlight these differences significantly. Conclusions: TNF- 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- was a more sensitive marker for different categories of sepsis compared to CRP and microbiology culture.