Plasma levels of cytokines in primary septic shock in humans: correlation with disease severity.
Thirteen patients (median age, 20 years) with life-threatening primary septic shock (10 meningococcal, 3 pneumococcal infections) were studied prospectively. All had a short history of sepsis (< or = 24 h) and no severe underlying disease. Two (15%) died. The logarithm of the initial plasma levels of tumor necrosis factor (TNF)-alpha, interleukin (IL)-1 beta, IL-6, IL-1 receptor antagonist (ra), and plasminogen activator inhibitor (PAI)-1 correlated significantly with APACHE II scores (r2 = .67, .57, .68, .81, and .68, respectively). The plasma levels of endotoxin, TNF-alpha, IL-1 beta, and PAI-1 decreased toward normal levels within the first 24 h of treatment, but IL-6 and IL-1ra levels remained high until clinical recovery. On admission, the molar excess of IL-1ra to IL-1 beta was > 2000-fold in 11 of the 13 patients. Acute plasmapheresis in 11 of the 13 patients significantly increased the plasma clearance of TNF-alpha (P = .02).
Gårdlund
B
B
Section for Infectious Diseases, Karolinska Hospital, Stockholm, Sweden.
Sjölin
J
J
Nilsson
A
A
Roll
M
M
Wickerts
C J
CJ
Wretlind
B
B
D000293:Adolescent; D000328:Adult; D015415:Biomarkers / Q000097:blood; D016207:Cytokines / Q000097:blood*; D005260:Female; D006801:Humans; D055504:Insulin Receptor Substrate Proteins; D007375:Interleukin-1 / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008589:Meningococcal Infections / Q000097:blood / Q000276:immunology / Q000503:physiopathology; D008875:Middle Aged; D010750:Phosphoproteins / Q000097:blood; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood; D011008:Pneumococcal Infections / Q000097:blood / Q000276:immunology / Q000503:physiopathology; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012772:Shock, Septic / Q000097:blood / Q000276:immunology* / Q000503:physiopathology*; D013997:Time Factors; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis
D015415:Biomarkers; D016207:Cytokines; C526292:IRS1 protein, human; D055504:Insulin Receptor Substrate Proteins; D007375:Interleukin-1; D015850:Interleukin-6; D010750:Phosphoproteins; D017395:Plasminogen Activator Inhibitor 1; D014409:Tumor Necrosis Factor-alpha