Pneumonia Requiring Respiratory Support in the PICU: Single-Center Study of Admission Plasma Nucleosome, Histone, and Citrullinated Histone H3 Levels in Relation to Complications.

IF 4 2区医学 Q1 CRITICAL CARE MEDICINE

Pediatric Critical Care Medicine Pub Date : 2025-07-10 DOI:10.1097/PCC.0000000000003785

Bin Li, Cuifen Li, Yunxiang Mao, Fangling Dong, Xishu Deng, Ling Hang, Tinghao Wu, Weihua Shou, Bo Zhang, Li Li, Tiesong Zhang, Lei Guo, Shufang Xiao

{"title":"Pneumonia Requiring Respiratory Support in the PICU: Single-Center Study of Admission Plasma Nucleosome, Histone, and Citrullinated Histone H3 Levels in Relation to Complications.","authors":"Bin Li, Cuifen Li, Yunxiang Mao, Fangling Dong, Xishu Deng, Ling Hang, Tinghao Wu, Weihua Shou, Bo Zhang, Li Li, Tiesong Zhang, Lei Guo, Shufang Xiao","doi":"10.1097/PCC.0000000000003785","DOIUrl":null,"url":null,"abstract":"Objectives: To investigate plasma nucleosome, histone H3 (H3), and citrullinated histone H3 (CitH3) levels in PICU patients with viral or bacterial pneumonia, and the associations with pediatric acute respiratory distress syndrome (PARDS) and sepsis.Design: Single-center observational study of plasma nucleosome, H3, and CitH3 levels collected within 24 hours of PICU admission in patients with pneumonia requiring respiratory support.Setting: A children's hospital PICU in Yunnan, China.Patients: Pneumonia patients and healthy controls seen during 2022-2024.Interventions: None.Measurements and main results: A total of 152 children (0.3-12 years old) with severe pneumonia were enrolled and, post hoc, 47 met the 2024 Phoenix criteria for sepsis, and 45 met the 2023 criteria for PARDS. Pneumonia in comparison with 22 controls was associated with higher levels of all three markers (nucleosome, p = 0.0006; H3, p = 0.003; and CitH3, p = 0.029). In comparison with non-sepsis and non-PARDS cases, the sepsis and PARDS categories were associated with higher levels of all three markers (sepsis, p < 0.0001, p = 0.015, p < 0.0001; PARDS, p = 0.003, p < 0.0001, p = 0.0002). The area under the receiver operating characteristic curve (AUROC) analysis with nucleosome level using the sepsis endpoint was 0.79 (95% CI, 0.71-0.87), p < 0.0001. The relationship between H3 and PARDS vs. non-ARDS patients was AUROC 0.83 (95% CI, 0.75-0.91), p < 0.0001; and there was a negative correlation with Pao2 to Fio2 of r -0.63 (p < 0.0001). Regarding, the association between bacterial vs. viral etiology of pneumonia, the combination of plasma CitH3 and C-reactive protein showed AUROC of 0.84 (95% CI, 0.76-0.92), p < 0.0001.Conclusions: In PICU patients with pneumonia requiring respiratory support, we detected significant plasma of nucleosome, H3, and CitH3 within the first 24 hours of admission. Furthermore, categorization as PARDS or sepsis was associated with higher levels of these biomarkers.","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0000,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Pediatric Critical Care Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/PCC.0000000000003785","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}

引用次数: 0

Abstract

Objectives: To investigate plasma nucleosome, histone H3 (H3), and citrullinated histone H3 (CitH3) levels in PICU patients with viral or bacterial pneumonia, and the associations with pediatric acute respiratory distress syndrome (PARDS) and sepsis.

Design: Single-center observational study of plasma nucleosome, H3, and CitH3 levels collected within 24 hours of PICU admission in patients with pneumonia requiring respiratory support.

Setting: A children's hospital PICU in Yunnan, China.

Patients: Pneumonia patients and healthy controls seen during 2022-2024.

Interventions: None.

Measurements and main results: A total of 152 children (0.3-12 years old) with severe pneumonia were enrolled and, post hoc, 47 met the 2024 Phoenix criteria for sepsis, and 45 met the 2023 criteria for PARDS. Pneumonia in comparison with 22 controls was associated with higher levels of all three markers (nucleosome, p = 0.0006; H3, p = 0.003; and CitH3, p = 0.029). In comparison with non-sepsis and non-PARDS cases, the sepsis and PARDS categories were associated with higher levels of all three markers (sepsis, p < 0.0001, p = 0.015, p < 0.0001; PARDS, p = 0.003, p < 0.0001, p = 0.0002). The area under the receiver operating characteristic curve (AUROC) analysis with nucleosome level using the sepsis endpoint was 0.79 (95% CI, 0.71-0.87), p < 0.0001. The relationship between H3 and PARDS vs. non-ARDS patients was AUROC 0.83 (95% CI, 0.75-0.91), p < 0.0001; and there was a negative correlation with Pao2 to Fio2 of r -0.63 (p < 0.0001). Regarding, the association between bacterial vs. viral etiology of pneumonia, the combination of plasma CitH3 and C-reactive protein showed AUROC of 0.84 (95% CI, 0.76-0.92), p < 0.0001.

Conclusions: In PICU patients with pneumonia requiring respiratory support, we detected significant plasma of nucleosome, H3, and CitH3 within the first 24 hours of admission. Furthermore, categorization as PARDS or sepsis was associated with higher levels of these biomarkers.

查看原文本刊更多论文

PICU中需要呼吸支持的肺炎：入院血浆核小体、组蛋白和瓜氨酸组蛋白H3水平与并发症的关系的单中心研究

目的：探讨病毒性或细菌性肺炎PICU患者血浆核小体、组蛋白H3 （H3）和瓜氨酸化组蛋白H3 （CitH3）水平及其与儿童急性呼吸窘迫综合征（PARDS）和败血症的关系。设计：对需要呼吸支持的肺炎患者PICU入院24小时内收集的血浆核小体、H3和CitH3水平进行单中心观察研究。地点：中国云南省某儿童医院PICU。患者：2022-2024年期间的肺炎患者和健康对照。干预措施:没有。测量和主要结果：共有152名患有严重肺炎的儿童（0.3-12岁）入组，其中47名符合2024年Phoenix脓毒症标准，45名符合2023年PARDS标准。与22个对照组相比，肺炎与所有三种标志物的较高水平相关(核小体，p = 0.0006；H3, p = 0.003；和CitH3， p = 0.029)。与非脓毒症和非PARDS病例相比，脓毒症和PARDS类别与所有三种标志物的较高水平相关(脓毒症，p < 0.0001, p = 0.015, p < 0.0001；PARDS, p = 0.003, p < 0.0001, p = 0.0002)。以脓毒症终点为终点，核小体水平的受试者工作特征曲线下面积（AUROC）分析为0.79 (95% CI, 0.71-0.87), p < 0.0001。与非ards患者相比，H3与PARDS的相关性为AUROC 0.83 (95% CI, 0.75 ~ 0.91), p < 0.0001；Pao2与Fio2呈负相关（r -0.63）（p < 0.0001）。对于肺炎的细菌病原学与病毒病原学的相关性，血浆中CitH3与c反应蛋白的联合AUROC为0.84 (95% CI, 0.76-0.92), p < 0.0001。结论：在PICU需要呼吸支持的肺炎患者中，我们在入院前24小时内检测到显著的核小体、H3和CitH3血浆。此外，归类为PARDS或败血症与这些生物标志物的较高水平相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Pediatric Critical Care Medicine 医学-危重病医学

CiteScore

7.40

自引率

14.60%

发文量

991

审稿时长

3-8 weeks

期刊介绍： Pediatric Critical Care Medicine is written for the entire critical care team: pediatricians, neonatologists, respiratory therapists, nurses, and others who deal with pediatric patients who are critically ill or injured. International in scope, with editorial board members and contributors from around the world, the Journal includes a full range of scientific content, including clinical articles, scientific investigations, solicited reviews, and abstracts from pediatric critical care meetings. Additionally, the Journal includes abstracts of selected articles published in Chinese, French, Italian, Japanese, Portuguese, and Spanish translations - making news of advances in the field available to pediatric and neonatal intensive care practitioners worldwide.