title: Prognostic value of cytokine concentrations (tumor necrosis factor-alpha, interleukin-6, and interleukin-10) and clinical parameters in severe melioidosis.
abstract: Raised serum concentrations of tumor necrosis factor (TNF)-alpha, interleukin (IL)-1beta, IL-6, or IL-10 are associated with mortality in patients with sepsis, but it is not known whether elevated cytokine levels are independently predictive of mortality. Cytokine assays (TNF-alpha, IL-6, and IL-10) were performed on admission plasma samples from 172 adult Thai patients with severe melioidosis. Mortality was 31.4%. APACHE II score; septicemia; plasma lactate; TNF-alpha, IL-6, and IL-10 concentrations; and IL-10/TNF-alpha and IL-6/IL-10 ratios were each associated with outcome (P</=.001 for all variables). Only the APACHE II score and either IL-6 or IL-10 concentration were independent predictors of mortality, as determined by use of multiple logistic regression (with cytokine concentrations and ratios entered separately). In a multivariate analysis, including both IL-6 and IL-10, the IL-10 concentration was no longer predictive. Therefore, APACHE II scores and either IL-6 or IL-10 concentration may be the most reliable parameters for stratification of patients in future studies of severe gram-negative sepsis.
authors.affiliation: Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand. andrew.simpson@ndm.ox.ac.uk
authors.forename: A J
authors.initials: AJ
authors.lastname: Simpson
authors.forename: M D
authors.initials: MD
authors.lastname: Smith
authors.forename: G J
authors.initials: GJ
authors.lastname: Weverling
authors.forename: Y
authors.initials: Y
authors.lastname: Suputtamongkol
authors.forename: B J
authors.initials: BJ
authors.lastname: Angus
authors.forename: W
authors.initials: W
authors.lastname: Chaowagul
authors.forename: N J
authors.initials: NJ
authors.lastname: White
authors.forename: S J
authors.initials: SJ
authors.lastname: van Deventer
authors.forename: J M
authors.initials: JM
authors.lastname: Prins
mesh_terms: D018806:APACHE; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000382:microbiology; D015415:Biomarkers / Q000097:blood; D016957:Burkholderia pseudomallei / Q000302:isolation & purification; D002442:Ceftazidime / Q000627:therapeutic use; D002511:Cephalosporins / Q000627:therapeutic use; D016207:Cytokines / Q000097:blood*; D005260:Female; D006801:Humans; D015378:Imipenem / Q000627:therapeutic use; D016753:Interleukin-10 / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D007773:Lactates / Q000097:blood; D016015:Logistic Models; D008297:Male; D008554:Melioidosis / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology* / Q000401:mortality*; D008875:Middle Aged; D011379:Prognosis; D013845:Thienamycins / Q000627:therapeutic use; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism
chemical_list: D015415:Biomarkers; D002511:Cephalosporins; D016207:Cytokines; D015850:Interleukin-6; D007773:Lactates; D013845:Thienamycins; D014409:Tumor Necrosis Factor-alpha; D016753:Interleukin-10; D015378:Imipenem; D002442:Ceftazidime