Title : IL-27 as a biomarker for distinguishing between necrotizing enterocolitis and highly suspected early-onset food protein-induced enterocolitis syndrome
Background: The initial clinical manifestations and abdominal imagines of neonates with necrotizing enterocolitis (NEC) and food protein-induced enterocolitis syndrome (FPIES) are sometimes similar, however, their prognosis and therapies are different. We aimed to evaluate the utility of interleukin(IL)-27 as an early differentiation marker between NEC and highly suspected early onset (HSEO)-FPIES.
Methods: The samples used in this study were all from the neonatal diagnosis center of Children’s Hospital. In the case-control study, neonates with jaundice (n=8), HSEO-FPIES (n=9),and NEC (n=13) were enrolled to determine the serum IL-27 levels using commercial enzyme-linked immune sorbent assay (ELISA) kits. In the validation cohort study, we included NEC (n = 87), HSEO-FPIES (n = 62),and jaundice(control, n = 54) groups to analyze the diagnostic efficiency of IL-27 for discriminating between NEC and FPIES using a receiver operating characteristic (ROC) curve.
Findings: In the case-control study, IL-27 levels were higher in the NEC group than in the HSEO-FPIES group (p=0·005).In the cohort study, the area under the ROC curve (AUC) ofIL-27 for differentiating NEC from HSEO-FPIES, was 0·878, which was higher thanIL-6 (0·761),C-reactive protein (0·800), white blood cell count (0·637), neutrophils (0·765), lymphocytes (0·782), neutrophil to lymphocyte ratio (0·781), and platelet count (0·729).
Interpretation: Serum IL-27 is a novel biomarker that may potentially discriminate NEC from HSEO-FPIES in neonates. FPIES is a relatively newly identified entity in the neonatal period and in some cases it remains difficult for early differentiation of HSEO-FPIES and NEC .To our knowledge, Our study was the first to explore a biomarker for discriminating between NEC and HSEO-FPIES in neonates in a relatively large sample size and may potentially help the neonatologists in decisions making