Assessment of Serum Tumor Necrosis Factor-Related Apoptosis-Inducing Ligand (TRAIL) in Children with Complicated and Uncomplicated Community Acquired Pneumonia

Background Community-acquired pneumonia (CAP) is a leading cause of hospitalization and death throughout the world. Tumor necrosis factor (TNF)-related apoptosis-inducing ligand (TRAIL) is a member of the TNF superfamily, which can trigger the apoptosis pathways and is implicated in several biological processes of pulmonary diseases. Aim To assess the correlation between serum TRAIL level in complicated and uncomplicated CAP children and their prognosis and to determine the risk factors of complications in children hospitalized with CAP in Pediatric Department Children's Hospital Ain Shams University. Methods we measured serum levels of TRAIL using enzyme linked immunosorbent assay in 30 patients with complicated CAP their age ranged from 1 year to 9 years with a median (IQR) of 4 (3 – 5) years and compared them to 30 patients with uncomplicated CAP their age ranged from 4 months to14 years with a median (IQR) of 2.5 (1 – 10) years and compared both groups to 20 age-and sex matched healthy children with a median age 3.5 years (range 5 months – 14 years). All included patients were subjected to the following 1. Detailed medical history with special emphasis on history of second hand smoking (passive exposure to cigarette smoke), duration of breast feeding, duration of symptoms before hospitalization, the duration of ward admission, need of PICU admission, interventions needed in management, need for surgical intervention and outcome.2. Thorough clinical examination laying stress on: Local chest examination. 3. Laboratory Investigations: CBC with differential, CRP and microbiological cultures. 4. Radiological investigations to confirm the diagnosis and determine the presence of complications or not: Chest X Ray, CT Chest (in complicated CAP patients) and Chest ultrasound. Results Serum TRAIL level was significantly higher in CAP patients than healthy controls with median (IOR)= 469.95 (323.9 - 743) ng/l and 41.44 (30.98 -51.16) ng/l respectively. Serum TRAIL level was significantly higher in complicated CAP patients than in uncomplicated CAP patients with median (IOR)= 743 (602–981.9) ng/l and 323.9 (236.3–422.6) ng/l respectively. second hand smoking (passive exposure to cigarette smoke) was significantly higher in complicated CAP patients than in uncomplicated CAP and healthy controls (P = 0.023). Shorter duration of breast feeding was significantly higher in complicated CAP patients than in uncomplicated CAP and healthy controls (P = 0.001). complicated and uncomplicated CAP patients were generally under-weight with median (IQR) Z score for weight 0 (-1 – 0) in complicated CAP and -1 (-2 – 0) for uncomplicated CAP. The duration of symptoms before hospitalization was significantly longer in complicated CAP patients than uncomplicated CAP patients with median (IOR)= 10 (7-15) days and 4 (2-7) days respectively. The duration of hospital admission was significantly longer in complicated CAP patients than uncomplicated CAP patients with median (IOR)= 21.5 (16-30) days and 7 (5-9) days respectively. the outcome of all patients was improvement with no mortality. Conclusion Serum TRAIL is statistically significant higher in complicated CAP patients compared to uncomplicated CAP patients; hence it can be regarded as biomarker for severity and complications among CAP children.