High cytokine levels at admission are associated with fatal outcome in patients with necrotizing fasciitis.
We evaluated in a blinded fashion the cytokine profiles of patients with suspected necrotizing fasciitis. In 15 out of 20 patients, the diagnosis of necrotizing fasciitis was established; five patients had cellulitis. Eighteen of the 20 patients were i.v. drug users. Five of the 15 patients with necrotizing fasciitis died (33%). On admission, serum levels for interleukin-1beta (IL-1beta), IL-1-receptor antagonist (IL-1Ra), IL-18 and interferon-gamma (IFNgamma) as well as white blood cells (WBC) were significantly elevated in patients with fatal outcome compared to survivors with necrotizing fasciitis. IL-1Ra and WBC levels were also higher than in patients with cellulitis. No differences were observed between patients groups for IL-6 and IL-8. In summary, significantly elevated levels of proinflammatory cytokines and particularly IL-1Ra are associated with fatal outcome in patients with necrotizing fasciitis. The measurement of proinflammatory cytokines and IL-1Ra may help to establish early diagnosis of life-threatening necrotizing fasciitis and thus to initiate aggressive treatment.
University of Colorado, Health Sciences Center, Denver, CO 80262, USA. lungstras@gmx.de
Kathrin
K
Lungstras-Bufler
Philip
P
Bufler
Rabiatu
R
Abdullah
Christine
C
Rutherford
Stefan
S
Endres
Edward
E
Abraham
Charles A
CA
Dinarello
Robert M
RM
Rodriguez
D000328:Adult; D002481:Cellulitis / Q000097:blood* / Q000473:pathology; D016207:Cytokines / Q000097:blood*; D019115:Fasciitis, Necrotizing / Q000097:blood* / Q000401:mortality / Q000473:pathology; D005260:Female; D006801:Humans; D053590:Interleukin 1 Receptor Antagonist Protein; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012795:Sialoglycoproteins / Q000097:blood*
D016207:Cytokines; C507763:IL1RN protein, human; D053590:Interleukin 1 Receptor Antagonist Protein; D012795:Sialoglycoproteins