Altered immune parameters in chronic alcoholic patients at the onset of infection and of septic shock.
BACKGROUND
Chronic alcoholic patients have a threefold to fourfold increased risk for developing a severe infection or septic shock after surgery, which might be due to altered immune response. The aim of this outcome matched study was to investigate proinflammatory and anti-inflammatory immune parameters during the course of infection and subsequent septic shock in chronic alcoholic patients, and to compare these parameters with those in nonalcoholic patients.


METHODS
Twenty-eight patients from a cohort of fifty-six with either pneumonia or peritonitis and subsequent septic shock were selected. Fourteen patients were chronic alcoholics whereas fourteen were nonalcoholic patients. Chronic alcoholic patients met criteria (Diagnostic and Statistical Manual of Mental Disorders IV, of the American Psychiatric Association) for alcohol abuse or dependence. Measurements were performed during the onset of infection (within 24 hours after the onset of infection), in early septic shock (within 12 hours after onset of septic shock) and in late septic shock (72 hours after the onset). Blood measurements included proinflammatory and anti-inflammatory cytokines.


RESULTS
Chronic alcoholic patients exhibited significantly lower plasma levels of IL-8 (P < 0.010) during the onset of infection than did matched nonalcoholic patients. In early septic shock, chronic alcoholic patients had significantly decreased levels of IL-1beta (P < 0.015), IL-6 (P < 0.016) and IL-8 (P < 0.010). The anti-inflammatory parameters IL-10 and tumour necrosis factor receptors I and II did not differ between alcoholic and nonalcoholic patients.


CONCLUSIONS
At the onset of infection and during early septic shock, chronic alcoholic patients had lower levels of proinflammatory immune parameters than did nonalcoholic patients. Therefore, immunomodulatory therapy administered early may be considered in chronic alcoholic patients at the onset of an infection because of their altered proinflammatory immune response.
von Dossow
Vera
V
Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany. vera.vdossow@charite.de <vera.vdossow@charite.de>
Schilling
Corinna
C
Beller
Stefan
S
Hein
Ortrud Vargas
OV
von Heymann
Christian
C
Kox
Wolfgang J
WJ
Spies
Claudia D
CD
D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000150:complications* / Q000276:immunology; D016022:Case-Control Studies; D002908:Chronic Disease; D006801:Humans; D007375:Interleukin-1 / Q000097:blood; D016753:Interleukin-10 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D008875:Middle Aged; D010538:Peritonitis / Q000150:complications* / Q000276:immunology*; D011014:Pneumonia / Q000150:complications* / Q000276:immunology*; D011237:Predictive Value of Tests; D018124:Receptors, Tumor Necrosis Factor / Q000097:blood; D012307:Risk Factors; D012772:Shock, Septic / Q000209:etiology / Q000276:immunology*; D014409:Tumor Necrosis Factor-alpha
D007375:Interleukin-1; D016209:Interleukin-8; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D016753:Interleukin-10