A pilot study of cytokine levels and white blood cell counts in the diagnosis of necrotizing fasciitis.
OBJECTIVE
To characterize the early cytokine response of patients presenting to the emergency department with necrotizing fasciitis (NF) and to determine whether serum cytokine levels and white blood cell (WBC) counts may be useful in distinguishing NF from other severe soft-tissue infections.


METHODS
White blood cell counts and cytokine levels (IL-1beta, IL-1Ra, IL-6, IL-8, IL-18, and IFN-gamma) were measured in patients presenting to the emergency department with severe soft-tissue infections and high suspicion of NF. Necrotizing fasciitis was confirmed intraoperatively and by surgical pathology. Cytokines were measured via the liquid-phase electrochemiluminescence method.


RESULTS
Thirty-five patients were enrolled, 18 were diagnosed with NF, and 17 were diagnosed with cellulitis and/or abscess (CAB). On admission, patients with NF had significantly higher WBC counts and lower levels of interleukin 1beta (IL-1beta) compared with patients with CAB. There were no statistically significant differences in the levels of the other cytokines between the 2 groups.


CONCLUSIONS
Patients with NF have higher WBC counts and lower IL-1beta levels compared with patients with CAB.
Rodriguez
Robert M
RM
Department of Emergency Services, San Francisco General Hospital, CA 94110, USA. rrodriguez@hghed.com
Abdullah
Rabiatu
R
Miller
Robert
R
Barry
Linda
L
Lungstras-Bufler
Kathrin
K
Bufler
Phillip
P
Dinarello
Charles A
CA
Abraham
Ed
E
D000038:Abscess / Q000097:blood* / Q000175:diagnosis / Q000382:microbiology; D000328:Adult; D002481:Cellulitis / Q000097:blood* / Q000175:diagnosis / Q000382:microbiology; D016207:Cytokines / Q000097:blood*; D003937:Diagnosis, Differential; D004636:Emergency Service, Hospital; D019115:Fasciitis, Necrotizing / Q000097:blood* / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies
D016207:Cytokines