Sepsis and serum cytokine concentrations.
OBJECTIVE
To look for relationships between the classification of sepsis and plasma cytokine concentrations.


METHODS
Prospective, consecutive entry study of patients meeting severe sepsis criteria and having bacteriologically documented infections.


METHODS
University hospital, surgical intensive care unit.


METHODS
Fifty consecutive patients developing severe sepsis or septic shock between December 1991 and December 1993.


RESULTS
Concentrations of tumor necrosis factor, interleukin (IL)-6, IL-8, and leukemia inhibitory factor were measured by immunoradiometric assay in the plasma of patients as soon as they developed severe sepsis or septic shock. Septic shock patients were divided into three groups in a blinded fashion (i.e., without knowing the results of the concentrations of cytokines), according to the presence of sustained hyperlactacidemia and to the rapidity of the onset of sepsis. Peak concentrations of all cytokines were statistically different between severe sepsis and septic shock patients. This finding was almost exclusively due to the data from patients with rapid onset of septic shock, who demonstrated very high but transient cytokine concentrations. Septic shock patients may thus have different profiles in the time course of their cytokine concentrations. The transient, high peak concentrations of cytokines were also related to transient leukopenia. Among the cytokines measured, IL-8 appeared to be the one that correlated best with lactacidemia, the presence of disseminated intravascular coagulation, severe hypoxemia, the Acute Physiology and Chronic Health Evaluation II score, and mortality rate.


CONCLUSIONS
According to the profiles of the cytokines, septic shock patients do not represent a homogeneous population. These profiles should be described in order to distinguish between patients, and the profiles may be useful to identify those patients susceptible to new therapies.
Damas
P
P
Department of Anesthesia, Centre Hospitalier Universitaire of Liège, Belgium.
Canivet
J L
JL
de Groote
D
D
Vrindts
Y
Y
Albert
A
A
Franchimont
P
P
Lamy
M
M
D018806:APACHE; D000140:Acidosis, Lactic / Q000382:microbiology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006131:Growth Inhibitors / Q000097:blood*; D006801:Humans; D015850:Interleukin-6 / Q000097:blood*; D016209:Interleukin-8 / Q000097:blood*; D053605:Leukemia Inhibitory Factor; D008222:Lymphokines / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018805:Sepsis / Q000097:blood / Q000145:classification / Q000276:immunology*; D016037:Single-Blind Method; D013997:Time Factors; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism*
D006131:Growth Inhibitors; D015850:Interleukin-6; D016209:Interleukin-8; C507837:LIF protein, human; D053605:Leukemia Inhibitory Factor; D008222:Lymphokines; D014409:Tumor Necrosis Factor-alpha