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Войти в исследования Frontiers in pediatrics · 2026
S100A8/A9 as a biomarker for differentiating pulmonary tuberculosis from community-acquired pneumonia in children: a multicenter cohort study in China.
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Li Xiaoxue, Li Xu, Fang Min, Liu Xiaomei, Duan Li, Li Ming, Fu Yanan, Wang Yanchun, Jiang Li, Yang Xiaotao, Jiang Tingting, Tang He, Tan Li, Wang Meifen, Liu Yang, Zhu Yu, Bi Jing, Shen Adong
Аннотация
BACKGROUND: Differentiating pulmonary tuberculosis (PTB) from community-acquired pneumonia (CAP) in children remains a significant diagnostic challenge. This study aimed to evaluate the diagnostic value of serum S100A8/A9 in pediatric populations.
METHODS: This multicenter prospective study enrolled 1,629 children aged 0∼≤ 18 years with definitive diagnostic classifications, including a discovery cohort (n = 1,092) and a validation cohort (n = 537). Participants were stratified into three groups: PTB (Confirmed, Unconfirmed), CAP (Viral, Bacterial, Mycoplasma pneumoniae, Mixed), and healthy controls (HC). Serum S100A8/A9 levels were quantified by enzyme-linked immunosorbent assay, and diagnostic performance was assessed using ROC analysis.
RESULTS: In both cohorts, S100A8/A9 levels were markedly lower in PTB than in CAP but higher than in healthy controls. (both p < 0.001). For distinguishing PTB from CAP, S100A8/A9 achieved AUC values of 0.916 (95% CI: 0.895-0.937, sensitivity 87.1%, specificity 81.8%) in the discovery cohort and 0.932 (95% CI: 0.906-0.958, sensitivity 87.5%, specificity 86.4%) in the validation cohort. Compared with all CAP etiological subgroups, PTB children had the lowest S100A8/A9 levels, with the highest AUC of 0.954 for PTB vs. Mycoplasma pneumoniae CAP. Age-stratified analysis revealed excellent discriminatory performance in children aged 5-18 years (AUC = 0.955 for PTB versus overall CAP). but impaired in children under 5 years (AUC = 0.838 for PTB versus overall CAP), with lower sensitivity (57.4%) for discriminating PTB from Viral-CAP. Furthermore, a concentration-dependent distribution was observed, with higher S100A8/A9 levels associated with a decreasing proportion of PTB and an increasing proportion of CAP. In children aged 5-18 years, levels < 1,000 ng/mL were predominantly PTB (92.1%), and levels > 1,900 ng/mL were highly predictive of CAP (96.8%).
CONCLUSIONS: Serum S100A8/A9 is a promising potential biomarker for distinguishing pediatric PTB from CAP, characterized by age-related distribution and concentration-dependent diagnostic pattern.
METHODS: This multicenter prospective study enrolled 1,629 children aged 0∼≤ 18 years with definitive diagnostic classifications, including a discovery cohort (n = 1,092) and a validation cohort (n = 537). Participants were stratified into three groups: PTB (Confirmed, Unconfirmed), CAP (Viral, Bacterial, Mycoplasma pneumoniae, Mixed), and healthy controls (HC). Serum S100A8/A9 levels were quantified by enzyme-linked immunosorbent assay, and diagnostic performance was assessed using ROC analysis.
RESULTS: In both cohorts, S100A8/A9 levels were markedly lower in PTB than in CAP but higher than in healthy controls. (both p < 0.001). For distinguishing PTB from CAP, S100A8/A9 achieved AUC values of 0.916 (95% CI: 0.895-0.937, sensitivity 87.1%, specificity 81.8%) in the discovery cohort and 0.932 (95% CI: 0.906-0.958, sensitivity 87.5%, specificity 86.4%) in the validation cohort. Compared with all CAP etiological subgroups, PTB children had the lowest S100A8/A9 levels, with the highest AUC of 0.954 for PTB vs. Mycoplasma pneumoniae CAP. Age-stratified analysis revealed excellent discriminatory performance in children aged 5-18 years (AUC = 0.955 for PTB versus overall CAP). but impaired in children under 5 years (AUC = 0.838 for PTB versus overall CAP), with lower sensitivity (57.4%) for discriminating PTB from Viral-CAP. Furthermore, a concentration-dependent distribution was observed, with higher S100A8/A9 levels associated with a decreasing proportion of PTB and an increasing proportion of CAP. In children aged 5-18 years, levels < 1,000 ng/mL were predominantly PTB (92.1%), and levels > 1,900 ng/mL were highly predictive of CAP (96.8%).
CONCLUSIONS: Serum S100A8/A9 is a promising potential biomarker for distinguishing pediatric PTB from CAP, characterized by age-related distribution and concentration-dependent diagnostic pattern.