Prognostic predictive values of serum cytochrome c, cytokines, and other laboratory measurements in acute encephalopathy with multiple organ failure.
OBJECTIVE
To evaluate the prognostic predictive values of cytochrome c, cytokines, and other laboratory measurements in serum collected during neurological onset in acute encephalopathy with multiple organ failure.


METHODS
In addition to general laboratory examinations, the concentrations of cytochrome c (apoptosis marker) and cytokines (inflammatory markers) were measured in serum samples collected at the initial phase in 29 patients with acute encephalopathy. The obtained values were evaluated as predictors for the development of severe encephalopathy.


RESULTS
Cytochrome c, tumour necrosis factor alpha (TNF-alpha), interleukin 6 (IL-6), soluble TNF-receptor 1 (sTNF-R1), and aspartate aminotransferase (AST) concentrations at the initial phase were high and correlated well with patient outcome. High concentrations of serum cytochrome c (>45 ng/ml), sTNF-R1 (>2000 pg/ml), AST (>58 IU/dl), IL-6 (>60 pg/ml), and TNF-alpha (>15 pg/ml) predicted an unfavourable prognosis (sequelae and death) at 93%, 79%, 82%, 77%, and 60%, respectively. The specificity of those markers was 100%, 89%, 83%, 100%, and 100%, respectively.


CONCLUSIONS
Serum cytochrome c is the most sensitive and specific predictor for the development of severe encephalopathy at the initial phase. Results suggest that this marker might be used to guide decisions regarding the start of the initial treatment and further intensive care.
Hosoya
M
M
Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan. mhosoya@fmu.ac.jp
Kawasaki
Y
Y
Katayose
M
M
Sakuma
H
H
Watanabe
M
M
Igarashi
E
E
Aoyama
M
M
Nunoi
H
H
Suzuki
H
H
D000208:Acute Disease; D019540:Area Under Curve; D001219:Aspartate Aminotransferases / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001929:Brain Edema / Q000097:blood; D002648:Child; D002675:Child, Preschool; D003422:Critical Care; D045304:Cytochromes c / Q000097:blood*; D016207:Cytokines / Q000097:blood*; D004660:Encephalitis / Q000097:blood* / Q000401:mortality / Q000628:therapy; D005260:Female; D006801:Humans; D007223:Infant; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D009102:Multiple Organ Failure / Q000097:blood* / Q000401:mortality / Q000628:therapy; D011379:Prognosis; D012372:ROC Curve; D018124:Receptors, Tumor Necrosis Factor / Q000097:blood; D012680:Sensitivity and Specificity; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis
D015415:Biomarkers; D016207:Cytokines; D015850:Interleukin-6; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D045304:Cytochromes c; D001219:Aspartate Aminotransferases