Cytokine patterns during dengue shock syndrome.
OBJECTIVE
To investigate the patterns of tumor necrosis factor-alpha (TNF-alpha), interleukin-1beta (IL-1beta), IL-6, interferon-gamma (IFN-gamma) and interleukin-1 receptor antagonist (IL-1Ra) during the course of dengue shock syndrome.


METHODS
Prospective clinical study.


METHODS
Pediatric Intensive Care Unit, Dr. Kariadi Hospital, the university hospital of Diponegoro University, Semarang, Indonesia.


METHODS
Fifty children with dengue shock syndrome.


METHODS
The plasma concentration and the ex vivo production, with and without lipopolysaccharide (LPS), of TNF-alpha, IL-1beta and IL-1Ra were measured in duplicate by nonequilibrium radioimmunoassay (RIA); IFN-gamma and IL-6 were measured by ELISA.


RESULTS
During the acute phase, the plasma concentrations and the ex vivo production without LPS of IL-1Ra were considerably elevated and returned to normal on recovery. However, the ex vivo LPS-stimulated production of the proinflammatory cytokines TNF-alpha and IL-1beta were considerably depressed. Also, these concentrations returned towards normal on recovery. In non-survivors, the plasma concentrations of IL-6 and IL-1Ra were significantly higher than in survivors (p = 0.00001 and p = 0.0005, respectively). In addition, the ex vivo production of IL-1Ra in non-survivors was significantly higher than in survivors, both without LPS stimulation (p = 0.0008) and with LPS (p < 0.004). IL-1Ra was significantly associated with mortality (p = 0.007).


CONCLUSIONS
Since IL-1Ra was significantly associated with mortality, this measurement may be used as an index of disease severity in dengue shock syndrome.
Suharti
Catharina
C
Department of Medicine, School of Medicine, Diponegoro University and Dr.Kariadi Hospital, Semarang, Indonesia.
van Gorp
Eric C M
EC
Dolmans
Wil M V
WM
Setiati
Tatty E
TE
Hack
C Erik
CE
Djokomoeljanto
Robert
R
van der Meer
Jos W M
JW
D002648:Child; D016207:Cytokines / Q000097:blood*; D004797:Enzyme-Linked Immunosorbent Assay; D006801:Humans; D007214:Indonesia / Q000453:epidemiology; D011446:Prospective Studies; D011863:Radioimmunoassay; D019595:Severe Dengue / Q000097:blood* / Q000401:mortality
D016207:Cytokines