Prognostic values of tumor necrosis factor/cachectin, interleukin-1, interferon-alpha, and interferon-gamma in the serum of patients with septic shock. Swiss-Dutch J5 Immunoglobulin Study Group.
Serum concentrations of immunoreactive tumor necrosis factor/cachectin (TNF), interleukin-1 beta (IL-1 beta), interferon-gamma (IFN gamma), and interferon-alpha (IFN alpha) were prospectively measured in 70 patients with septic shock to determine their evolution and prognostic values. In a univariate analysis, levels of TNF (P = .002) and IL-1 beta (P = .05) were associated with the patient's outcome, but not IFN alpha (P = .15) and IFN gamma (P = .26). In contrast, in a stepwise logistic regression analysis, the severity of the underlying disease (P = .01), the age of the patient (P = .02), the documentation of infection (nonbacteremic infections vs. bacteremias, P = .03), the urine output (P = .04), and the arterial pH (P = .05) contributed more significantly to prediction of patient outcome than the serum levels of TNF (P = .07). After 10 days, the median concentration of TNF was undetectable (less than 100 pg/ml) in the survivors, whereas it remained elevated (305 pg/ml, P = .002) in the nonsurvivors. Thus, in patients with septic shock due to various gram-negative bacteria, other parameters than the absolute serum concentration of immunoreactive TNF contributed significantly to the prediction of outcome.
Calandra
T
T
Department of Internal Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Baumgartner
J D
JD
Grau
G E
GE
Wu
M M
MM
Lambert
P H
PH
Schellekens
J
J
Verhoef
J
J
Glauser
M P
MP
D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D002648:Child; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007370:Interferon Type I / Q000097:blood*; D007371:Interferon-gamma / Q000097:blood*; D007375:Interleukin-1 / Q000032:analysis*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011897:Random Allocation; D012044:Regression Analysis; D012772:Shock, Septic / Q000175:diagnosis*; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis*
D007370:Interferon Type I; D007375:Interleukin-1; D014409:Tumor Necrosis Factor-alpha; D007371:Interferon-gamma