Lipopolysaccharide (LPS)-Induced Tumor Necrosis Factor-Alpha (TNF-ɑ) Levels and Health Care Associated Infection (HAI) in Children with Multi-Organ Dysfunction Syndrome (MODS).

The present study estimated lipopolysaccharide (LPS)-induced tumor necrosis factor-alpha (TNF-α) levels and its association with health care associated infection (HAI) and duration of multi-organ dysfunction syndrome (MODS). LPS-induced TNF-α levels were estimated in 67 children on day 3 of MODS. Variables recorded were Pediatric Index of Mortality (PIM-3), cultures, diagnosis, HAI, days of MODS, survivors and non-survivors. Of 67 children, 37 (52.2%) were male and 27 (40.2%) expired. Sixty-three (94%) children had reduced TNF-α levels (<200 pg/ml); 23.11 (10.38, 40.59). The median number of days in MODS was 7 (5, 12) and prolonged MODS (≥7 d) was observed in 49/67 (73.1%) children. Forty-five (67.1%) children had HAI, among these 33/45 (73.3%) had ventilator associated pneumonia (VAP). TNF-α levels were significantly lower in children with MODS, prolonged MODS, children who developed HAI and non-survivors as compared to healthy children (p <0.0001), children with MODS <7 d (p=0.01), children without HAI (p=0.009) and survivors (p=0.04), respectively. HAI was independently associated with reduced levels of TNF-α (p=0.01).