[Study of cytokines kinetics in severe sepsis and its relationship with mortality and score of organic dysfunction].
BACKGROUND
The Infectious Systemic Inflammatory Response syndrome and multiple organic dysfunction have common physiopathological mechanisms. Multiple organic dysfunction can be assessed using severity scores.


OBJECTIVE
To relate cytokine kinetics with a multiple organic dysfunction score during sepsis.


METHODS
Tumor necrosis factor alpha (TNF alpha) and interleukin 6 (IL6) kinetics were studied in 25 patients with severe sepsis with less than 48 h of evolution and interleukin 1 beta (IL beta) kinetics was studied in 13 patients. Measurements were made at 0, 12, 24 and 48 hours after admission to the study, using an ELISA technique. These parameters were correlated with the Marshall multiple organic dysfunction score and survival.


RESULTS
Mean age of study subjects was 70 years, the APACHE II score was 16.9 +/- 6 and the Marshall score was 6.8 +/- 3.6. Sepsis was of pulmonary origin in 56% of patients and intra abdominal in 32%. Mortality was 36%. TNF alpha increased during the study period (24.1 pg/ml initially and 37.8 pg/ml at 24 hours, with a slight posterior reduction, p < 0.02). These levels had no association with mortality or organic dysfunction. IL6 remained elevated during the first hours and had a tendency to decrease thereafter. Decreased patients had higher values than survivors (306 pg/ml and 55.4 pg/ml respectively, p = 0.011). Its values were tightly correlated with Marshall score, with the number of failing organs, with the presence of shock and with probability of dying during hospitalization. IL1 beta remained low and was not associated with clinical parameters.


CONCLUSIONS
There is a tight correlation between the elevation of IL6 and the severity of the Systemic Inflammatory Response and mortality in these patients with sepsis.
Dougnac
A
A
Programa de Medicina Intensiva, Departamentos de Medicina Interna, Salud Pública y Reumatología, Escuela de Medicina, Pontificia Universidad Católica de Chile. dougnac@med.puc.cl
Riquelme
A
A
Calvo
M
M
Andresen
M
M
Magedzo
A
A
Eugenin
E
E
Marshall
G
G
Gutiérrez
M
M
Eugeni
E
E
D018806:APACHE; D000368:Aged; D016207:Cytokines / Q000097:blood / Q000378:metabolism*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007375:Interleukin-1 / Q000097:blood / Q000378:metabolism; D015850:Interleukin-6 / Q000097:blood / Q000378:metabolism; D008297:Male; D009102:Multiple Organ Failure / Q000378:metabolism / Q000401:mortality*; D011446:Prospective Studies; D018805:Sepsis / Q000378:metabolism / Q000401:mortality*; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000378:metabolism / Q000401:mortality; D018746:Systemic Inflammatory Response Syndrome / Q000378:metabolism / Q000401:mortality; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism
D016207:Cytokines; D007375:Interleukin-1; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha