Monocyte tumor necrosis factor receptor levels as a predictor of risk in human sepsis.
OBJECTIVE
To assess peripheral blood monocyte tumor necrosis factor receptor (TNFR) levels and plasma soluble tumor necrosis factor receptor (sTNFR) concentrations in critically ill patients with sepsis syndrome.


METHODS
Prospective, descriptive cohort study with no interventions.


METHODS
Surgical intensive care unit of a tertiary-care hospital associated with a university medical school.


METHODS
Twenty-one patients with a documented source of infection who met currently accepted criteria for sepsis syndrome/septic shock.


METHODS
Plasma sTNFR p55 and p75 values were quantified by enzyme-linked immunosorbent assay, and monocyte TNFR levels were assessed by fluorescence flow cytometry after the monocytes were stained with biotinylated human recombinant TNF-alpha and streptavidin-phycoerythrin.


RESULTS
Compared with healthy controls, plasma sTNFR p55 and p75 values were significantly higher (P <.01) in both surviving and nonsurviving patients with sepsis; in nonsurviving patients with sepsis, however, only sTNFR p55 values were significantly (P < .05) higher than in surviving patients with sepsis. By contrast, monocytes from the nonsurviving patients with sepsis manifested a significant (P < .01) and sustained (up to 4 days) decrease in cell surface TNFR values compared with either the normal controls or the surviving patients with sepsis.


CONCLUSIONS
Assessment of monocyte surface TNFR values may provide a rapid prognostic indicator for patients with sepsis who are at increased risk of death.
Calvano
S E
SE
Department of Surgery, Cornell University Medical College, New York, NY, USA.
van der Poll
T
T
Coyle
S M
SM
Barie
P S
PS
Moldawer
L L
LL
Lowry
S F
SF
D000704:Analysis of Variance; D006801:Humans; D009000:Monocytes / Q000378:metabolism*; D011379:Prognosis; D011446:Prospective Studies; D018124:Receptors, Tumor Necrosis Factor / Q000378:metabolism*; D012307:Risk Factors; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood*
D018124:Receptors, Tumor Necrosis Factor