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ARTICLE

Plasma Cytokine and Endotoxin Levels Correlate with Survival in Patients with the Sepsis Syndrome

right arrow Larry C. Casey; Robert A. Balk; and Roger C. Bone

15 October 1993 | Volume 119 Issue 8 | Pages 771-778

Objective: To determine whether plasma tumor necrosis factor-{alpha} (TNF-{alpha}), 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.

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-{alpha}, 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.

Results: Fifty-four percent of patients with the sepsis syndrome had detectable levels of TNF-{alpha} (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-{alpha}, 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-{alpha}, 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).

Conclusions: Patients with the sepsis syndrome have detectable levels of circulating TNF-{alpha}, 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.

Author and Article Information
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From Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois.
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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FASEB J.Home page
C. OBERHOLZER, A. OBERHOLZER, M. CLARE-SALZLER, and L. L. MOLDAWER
Apoptosis in sepsis: a new target for therapeutic exploration
FASEB J, April 1, 2001; 15(6): 879 - 892.
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J. Immunol.Home page
L. A. Doughty, K. B. Nguyen, J. E. Durbin, and C. A. Biron
A Role for IFN-{{alpha}}{{beta}} in Virus Infection-Induced Sensitization to Endotoxin
J. Immunol., February 15, 2001; 166(4): 2658 - 2664.
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Innate ImmunityHome page
M.-J. Dubois and J.-L. Vincent
Clinically-oriented therapies in sepsis: a review
Innate Immunity, December 1, 2000; 6(6): 463 - 469.
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Infect. Immun.Home page
P. K. Murthy, V. A. Dennis, B. L. Lasater, and M. T. Philipp
Interleukin-10 Modulates Proinflammatory Cytokines in the Human Monocytic Cell Line THP-1 Stimulated with Borrelia burgdorferi Lipoproteins
Infect. Immun., December 1, 2000; 68(12): 6663 - 6669.
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J. Immunol.Home page
G. H. Chen, R. C. Reddy, M. W. Newstead, K. Tateda, B. L. Kyasapura, and T. J. Standiford
Intrapulmonary TNF Gene Therapy Reverses Sepsis-Induced Suppression of Lung Antibacterial Host Defense
J. Immunol., December 1, 2000; 165(11): 6496 - 6503.
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Anesth. Analg.Home page
K. Nakanishi, S. Takeda, K. Terajima, T. Takano, and R. Ogawa
Myocardial Dysfunction Associated with Proinflammatory Cytokines After Esophageal Resection
Anesth. Analg., August 1, 2000; 91(2): 270 - 275.
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Am. J. Physiol. Regul. Integr. Comp. Physiol.Home page
L. L. Loftis, C. A. Johanns, A. J. Lechner, and G. M. Matuschak
Brief hypoxic stress suppresses postbacteremic NF-kappa B activation and TNF-alpha bioactivity in perfused liver
Am J Physiol Regulatory Integrative Comp Physiol, July 1, 2000; 279(1): R99 - R108.
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Arterioscler. Thromb. Vasc. Bio.Home page
H. Gierens, M. Nauck, M. Roth, R. Schinker, C. Schurmann, H. Scharnagl, G. Neuhaus, H. Wieland, and W. Marz
Interleukin-6 Stimulates LDL Receptor Gene Expression via Activation of Sterol-Responsive and Sp1 Binding Elements
Arterioscler. Thromb. Vasc. Biol., July 1, 2000; 20(7): 1777 - 1783.
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Infect. Immun.Home page
F. Arnalich, E. Garcia-Palomero, J. Lopez, M. Jimenez, R. Madero, J. Renart, J. J. Vazquez, and C. Montiel
Predictive Value of Nuclear Factor kappa B Activity and Plasma Cytokine Levels in Patients with Sepsis
Infect. Immun., April 1, 2000; 68(4): 1942 - 1945.
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Infect. Immun.Home page
D. J. Kwak, N. H. Augustine, W. G. Borges, J. L. Joyner, W. F. Green, and H. R. Hill
Intracellular and Extracellular Cytokine Production by Human Mixed Mononuclear Cells in Response to Group B Streptococci
Infect. Immun., January 1, 2000; 68(1): 320 - 327.
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Anesth. Analg.Home page
M. A. Weigand, H. Schmidt, Q. Zhao, K. Plaschke, E. Martin, and H. J. Bardenheuer
Ketamine Modulates the Stimulated Adhesion Molecule Expression on Human Neutrophils In Vitro
Anesth. Analg., January 1, 2000; 90(1): 206 - 206.
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Infect. Immun.Home page
S. Ebong, D. Call, J. Nemzek, G. Bolgos, D. Newcomb, and D. Remick
Immunopathologic Alterations in Murine Models of Sepsis of Increasing Severity
Infect. Immun., December 1, 1999; 67(12): 6603 - 6610.
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Am. J. Respir. Crit. Care Med.Home page
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.
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Am. J. Respir. Crit. Care Med.Home page
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.
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Arch SurgHome page
P. A. Ward and A. B. Lentsch
The Acute Inflammatory Response and Its Regulation
Arch Surg, June 1, 1999; 134(6): 666 - 669.
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Am. J. Physiol. Heart Circ. Physiol.Home page
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.
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J. Biol. Chem.Home page
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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CirculationHome page
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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Am. J. Physiol. Regul. Integr. Comp. Physiol.Home page
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.
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Am. J. Physiol. Gastrointest. Liver Physiol.Home page
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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Arch SurgHome page
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.
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Am. J. Respir. Crit. Care Med.Home page
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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Arch Intern MedHome page
P. A. Mackowiak
Concepts of Fever
Arch Intern Med, September 28, 1998; 158(17): 1870 - 1881.
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Am. J. Physiol. Lung Cell. Mol. Physiol.Home page
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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NEJMHome page
F. D. Lowy
Staphylococcus aureus Infections
N. Engl. J. Med., August 20, 1998; 339(8): 520 - 532.
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Ann. Thorac. Surg.Home page
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.
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Am. J. Physiol. Regul. Integr. Comp. Physiol.Home page
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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Infect. Immun.Home page
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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JPEN J Parenter Enteral NutrHome page
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.
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Infect. Immun.Home page
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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Circ. Res.Home page
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.
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Am. J. Physiol. Regul. Integr. Comp. Physiol.Home page
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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CirculationHome page
K. Bhagat and P. Vallance
Inflammatory Cytokines Impair Endothelium-Dependent Dilatation in Human Veins In Vivo
Circulation, November 4, 1997; 96(9): 3042 - 3047.
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Am. J. Respir. Crit. Care Med.Home page
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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Am. J. Respir. Crit. Care Med.Home page
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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Innate ImmunityHome page
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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