title: Macrophage migration inhibitory factor is a critical mediator of systemic inflammatory response syndrome.
abstract: OBJECTIVE
  To determine the relations between macrophage migration inhibitory factor (MIF), tumor necrosis factor-alpha (TNF-alpha), interferon-gamma (IFN-gamma), and cortisol in patients with systemic inflammatory response syndrome (SIRS) and to determine whether their levels correlate with patient survival.
  
  
  METHODS
  Prospective, observational, cohort study.
  
  
  METHODS
  General intensive care unit in a university hospital.
  
  
  METHODS
  The study included 17 consecutive patients who met the criteria for SIRS; the patients were classified into subgroups, survivors (n = 8) and nonsurvivors (n = 9); eight healthy volunteers served as control subjects.
  
  
  METHODS
  None.
  
  
  RESULTS
  Serum MIF, TNF-alpha, IFN-gamma, and cortisol levels were measured serially when the patients were first identified as having SIRS (day 0), and on days 1-4. Except for the high tendency of acute respiratory distress syndrome in nonsurvivors (44%) compared to survivors (13%), there were no differences in the clinical backgrounds of the patients between the two groups. All patients had multiple organ dysfunction syndrome. The values of MIF and TNF-alpha in the nonsurvivors were significantly more elevated than those cytokines measured in the survivors and control subjects. Peak MIF levels significantly correlated with peak TNF-alpha levels (r2 = 0.448, P = 0.002), but did not correlate with peak levels of cortisol and IFN-gamma. Although the levels of IFN-gamma and cortisol showed a marked increase compared to those of the control subjects, we could not find differences in these variables between the survivors and the nonsurvivors.
  
  
  CONCLUSIONS
  High MIF and TNF-alpha levels are closely linked with poor outcome in patients with SIRS. MIF and TNF-alpha may act together and have pathogenic roles in SIRS.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Hokkaido University School of Medicine, Sapporo, Japan. sgando@med.hokudai.ac.jp
authors.forename: S
authors.initials: S
authors.lastname: Gando
authors.forename: J
authors.initials: J
authors.lastname: Nishihira
authors.forename: S
authors.initials: S
authors.lastname: Kobayashi
authors.forename: Y
authors.initials: Y
authors.lastname: Morimoto
authors.forename: S
authors.initials: S
authors.lastname: Nanzaki
authors.forename: O
authors.initials: O
authors.lastname: Kemmotsu
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007371:Interferon-gamma / Q000097:blood; D007564:Japan / Q000453:epidemiology; D016018:Least-Squares Analysis; D008263:Macrophage Migration-Inhibitory Factors / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D015996:Survival Rate; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood* / Q000401:mortality; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism
chemical_list: D008263:Macrophage Migration-Inhibitory Factors; D014409:Tumor Necrosis Factor-alpha; D007371:Interferon-gamma; D006854:Hydrocortisone