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15 October 1993 | Volume 119 Issue 8 | Pages 771-778
Objective: To determine whether plasma tumor necrosis factor-
Design: Prospective study comparing patients with the sepsis syndrome, critically ill patients without sepsis, and normal healthy volunteers.
Setting: Tertiary care hospital affiliated with a medical school.
Patients: The study included 97 consecutive patients on a medical service who met the criteria for the sepsis syndrome; 20 critically ill patients without sepsis who were in the medical intensive care unit; and 20 healthy volunteers who served as comparison groups.
Measurements: Plasma tumor necrosis factor-
Results: Fifty-four percent of patients with the sepsis syndrome had detectable levels of TNF-
Conclusions: Patients with the sepsis syndrome have detectable levels of circulating TNF-
Author and Article Information
From Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois.
ARTICLE
Plasma Cytokine and Endotoxin Levels Correlate with Survival in Patients with the Sepsis Syndrome
(TNF-
), interleukin-1 ß (IL-1 ß), interleukin-6 (IL-6), and lipopolysaccharide are detectable in patients when they first present with the sepsis syndrome and to determine whether levels correlate with patient survival.
, IL-1 ß, interleukin-6, and endotoxin (lipopolysaccharide) levels were measured when a patient was first identified as having the sepsis syndrome. Survival was defined as being alive 30 days after the sepsis syndrome was diagnosed.
(median, 26 pg/mL; range, nondetectable to 1000 pg/mL); 37% had detectable levels of IL-1 (median, 20 pg/mL; range, nondetectable to 2850 pg/mL); 80% had detectable levels of IL-6 (median, 415 pg/mL; range, nondetectable to 2380 pg/mL); and 89% had detectable levels of lipopolysaccharide (median, 2.6; range, nondetectable to 12.5 endotoxin units [EU]/mL). In all cases, levels were higher than those in critically ill patients without sepsis and normal healthy controls (P < 0.001 for all comparisons). Plasma levels of TNF-
, IL-1 ß, IL-6, and lipopolysaccharide were detectable in patients regardless of culture status. The IL-6 level was 69% (95% CI, 30% to 108%) higher in patients who died compared with those who survived. The scores for the individual levels of TNF-
, IL-1 ß, IL-6, and lipopolysaccharide were summed to arrive at a total lipopolysaccharide-cytokine score, and mortality increased with lipopolysaccharide-cytokine score (P < 0.001).
, IL-1, IL-6, and lipopolysaccharide independent of culture-documented infection. Lipopolysaccharide and cytokines may play a pathogenic role in sepsis, and the combination of several elevated factors may be important in determining patient survival.
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Requests for Reprints: Larry C. Casey, MD, PhD, Rush-Presbyterian-St. Luke's Medical Center, Department of Pulmonary and Critical Care Medicine, 1725 West Harrison Street, Suite 306, Chicago, IL 60612.
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K. R. WALLEY, T. E. MCDONALD, Y. HIGASHIMOTO, and S. HAYASHI Modulation of Proinflammatory Cytokines by Nitric Oxide in Murine Acute Lung Injury Am. J. Respir. Crit. Care Med., August 1, 1999; 160(2): 698 - 704. [Abstract] [Full Text] |
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E. M. DROST, G. KASSABIAN, H. J. MEISELMAN, D. GELMONT, and T. C. FISHER Increased Rigidity and Priming of Polymorphonuclear Leukocytes in Sepsis Am. J. Respir. Crit. Care Med., June 1, 1999; 159(6): 1696 - 1702. [Abstract] [Full Text] |
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P. A. Ward and A. B. Lentsch The Acute Inflammatory Response and Its Regulation Arch Surg, June 1, 1999; 134(6): 666 - 669. [Abstract] [Full Text] [PDF] |
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S. Yasuda and W. Y. W. Lew Angiotensin II exacerbates lipopolysaccharide-induced contractile depression in rabbit cardiac myocytes Am J Physiol Heart Circ Physiol, May 1, 1999; 276(5): H1442 - H1449. [Abstract] [Full Text] [PDF] |
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P. A. Majcherczyk, H. Langen, D. Heumann, M. Fountoulakis, M. P. Glauser, and P. Moreillon Digestion of Streptococcus pneumoniae Cell Walls with Its Major Peptidoglycan Hydrolase Releases Branched Stem Peptides Carrying Proinflammatory Activity J. Biol. Chem., April 30, 1999; 274(18): 12537 - 12543. [Abstract] [Full Text] [PDF] |
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L. M. Biasucci, G. Liuzzo, G. Fantuzzi, G. Caligiuri, A. G. Rebuzzi, F. Ginnetti, C. A. Dinarello, and A. Maseri Increasing Levels of Interleukin (IL)-1Ra and IL-6 During the First 2 Days of Hospitalization in Unstable Angina Are Associated With Increased Risk of In-Hospital Coronary Events Circulation, April 27, 1999; 99(16): 2079 - 2084. [Abstract] [Full Text] [PDF] |
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A. Kumar, R. Brar, P. Wang, L. Dee, G. Skorupa, F. Khadour, R. Schulz, and J. E. Parrillo Role of nitric oxide and cGMP in human septic serum-induced depression of cardiac myocyte contractility Am J Physiol Regulatory Integrative Comp Physiol, January 1, 1999; 276(1): R265 - R276. [Abstract] [Full Text] [PDF] |
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K. M. Andrejko, J. Chen, and C. S. Deutschman Intrahepatic STAT-3 activation and acute phase gene expression predict outcome after CLP sepsis in the rat Am J Physiol Gastrointest Liver Physiol, December 1, 1998; 275(6): G1423 - G1429. [Abstract] [Full Text] [PDF] |
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S. E. Calvano, S. M. Coyle, K. S. Barbosa, P. S. Barie, and S. F. Lowry Multivariate Analysis of 9 Disease-Associated Variables for Outcome Prediction in Patients With Sepsis Arch Surg, December 1, 1998; 133(12): 1347 - 1350. [Abstract] [Full Text] [PDF] |
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A. H. M. FROON, M. J. M. BONTEN, C. A. GAILLARD, J. W. M. GREVE, M. A. DENTENER, P. W. de LEEUW, M. DRENT, E. E. STOBBERINGH, and W. A. BUURMAN Prediction of Clinical Severity and Outcome of Ventilator-associated Pneumonia . Comparison of Simplified Acute Physiology Score with Systemic Inflammatory Mediators Am. J. Respir. Crit. Care Med., October 1, 1998; 158(4): 1026 - 1031. [Abstract] [Full Text] [PDF] |
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P. A. Mackowiak Concepts of Fever Arch Intern Med, September 28, 1998; 158(17): 1870 - 1881. [Abstract] [Full Text] |
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C. Hierholzer, J. C. Kalff, L. Omert, K. Tsukada, J. E. Loeffert, S. C. Watkins, T. R. Billiar, and D. J. Tweardy Interleukin-6 production in hemorrhagic shock is accompanied by neutrophil recruitment and lung injury Am J Physiol Lung Cell Mol Physiol, September 1, 1998; 275(3): L611 - L621. [Abstract] [Full Text] [PDF] |
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F. D. Lowy Staphylococcus aureus Infections N. Engl. J. Med., August 20, 1998; 339(8): 520 - 532. [Full Text] [PDF] |
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L. A. Brasil, W. J. Gomes, R. Salomao, and E. Buffolo Inflammatory response after myocardial revascularization with or without cardiopulmonary bypass Ann. Thorac. Surg., July 1, 1998; 66(1): 56 - 59. [Abstract] [Full Text] [PDF] |
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L. R. Leon, A. A. White, and M. J. Kluger Role of IL-6 and TNF in thermoregulation and survival during sepsis in mice Am J Physiol Regulatory Integrative Comp Physiol, July 1, 1998; 275(1): R269 - R277. [Abstract] [Full Text] [PDF] |
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W. A. Nockher and J. E. Scherberich Expanded CD14+ CD16+ Monocyte Subpopulation in Patients with Acute and Chronic Infections Undergoing Hemodialysis Infect. Immun., June 1, 1998; 66(6): 2782 - 2790. [Abstract] [Full Text] [PDF] |
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H. R. Chang and B. Bistrian Review: The Role of Cytokines in the Catabolic Consequences of Infection and Injury JPEN J Parenter Enteral Nutr, May 1, 1998; 22(3): 156 - 166. [Abstract] [PDF] |
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L. C. Denlinger, K. A. Garis, J. A. Sommer, A. G. Guadarrama, R. A. Proctor, and P. J. Bertics Nuclear Translocation of NF-kappa B in Lipopolysaccharide-Treated Macrophages Fails To Correspond to Endotoxicity: Evidence Suggesting a Requirement for a Gamma Interferon-Like Signal Infect. Immun., April 1, 1998; 66(4): 1638 - 1647. [Abstract] [Full Text] [PDF] |
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S. Yasuda and W. Y. W. Lew Lipopolysaccharide Depresses Cardiac Contractility and ß-Adrenergic Contractile Response by Decreasing Myofilament Response to Ca2+ in Cardiac Myocytes Circ. Res., December 19, 1997; 81(6): 1011 - 1020. [Abstract] [Full Text] |
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T. Van Der Poll and S. F. Lowry Epinephrine inhibits endotoxin-induced IL-1beta production: roles of tumor necrosis factor-alpha and IL-10 Am J Physiol Regulatory Integrative Comp Physiol, December 1, 1997; 273(6): R1885 - R1890. [Abstract] [Full Text] [PDF] |
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K. Bhagat and P. Vallance Inflammatory Cytokines Impair Endothelium-Dependent Dilatation in Human Veins In Vivo Circulation, November 4, 1997; 96(9): 3042 - 3047. [Abstract] [Full Text] |
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M. J. M. BONTEN, A. H. M. FROON, C. A. GAILLARD, J. W. M. GREVE, P. W. de LEEUW, M. DRENT, E. E. STOBBERINGH, and W. A. BUURMAN The Systemic Inflammatory Response in the Development of Ventilator-Associated Pneumonia Am. J. Respir. Crit. Care Med., October 1, 1997; 156(4): 1105 - 1113. [Abstract] [Full Text] [PDF] |
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E. PRESTERL, T. STAUDINGER, M. PETTERMANN, A. LASSNIGG, H. BURGMANN, S. WINKLER, M. FRASS, and W. GRANINGER Cytokine Profile and Correlation to the APACHE III and MPM II Scores in Patients with Sepsis Am. J. Respir. Crit. Care Med., September 1, 1997; 156(3): 825 - 832. [Abstract] [Full Text] [PDF] |
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K. Laczika, S. Knapp, G.J. Locker, F. Thalhammer, B. Stoiser, M. Frass, and H. Burgmann Tremendous high plasma lipopolysaccharide concentrations in a patient with Legionella pneumophila pneumonia Innate Immunity, August 1, 1997; 4(4): 301 - 304. [Abstract] [PDF] |
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