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Cytokine Levels Signal Worse Prognosis in Severe Sepsis
A DGReview of :"Decreased Cytokine Expression in Peripheral Blood Leukocytes of Patients With Severe Sepsis"
Archives of Surgery
09/20/2002
By Veronica Rose
Diminished lymphocyte- and monocyte-associated pro- and anti-inflammatory cytokine levels appear to be associated with a worse prognosis in patients with sepsis.
Researchers at the University of Istanbul, Turkey, note that previous reports have shown high levels of tumour necrosis factor (TNF), a messenger RNA's, and interleukin (IL) 8 in sepsis. But, they hypothesized that assessment of leukocyte intracytoplasmic levels of pro-inflammatory and anti-inflammatory cytokines might be clinically more relevant to determine prognosis in patients with severe sepsis.
Sixteen patients in a surgical intensive unit provided leucocyte suspensions. Six of these were obtained during early sepsis, or septic shock, and 10 during later sepsis or septic shock. These suspensions were initially incubated with anti-CD14 and anti-CD2 or anti-CD3 monoclonal antibodies. They were then incubated with intracytoplasmic antibodies staining for interferon g, TNF-a, IL 2,IL-6, IL-8, IL-10 and IL 12 before undergoing analysis with a flow cytometer.
Outcome measures were 28-day all-cause mortality rates and multiple organ dysfunction and sepsis-related organ failure assessment scores. High scores were defined as greater than or equal to the median values of 8 for the multiple organ dysfunction score, or 11 for the sepsis-related organ failure assessment score.
Researchers identified higher levels of serum interleukin (6 and 8), C-reactive protein and procalcitonin in patients with high multiple organ dysfunction and sepsis-related organ failure assessment scores. They also found decreased T lymphocyte IL-6, TNF-a and monocyte-associated 1L-10 and 12 proportions.
They also noted that analysis of the 28-day all-cause mortality rates found higher levels of C-reactive protein and procalcitonin in the nine non-survivors than in seven survivors. There was a decrease in non-survivors of T-lymphocyte-associated Interleukin- 2, -6, -10, TNF-a and monocyte IL-10 and TNF-a proportions.
Archives of Surgery September 2002 Vol 137 No 9 pp 1037-1043.
"Decreased Cytokine Expression in Peripheral Blood Leukocytes of Patients With Severe Sepsis"
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