title: Plasma pro- and anti-inflammatory cytokine levels and outcome prediction in unselected critically ill patients.
abstract: OBJECTIVE
  To determine the inter-relationships between cytokine levels and physiological scores in predicting outcome in unselected, critically ill patients.
  
  
  METHODS
  To this end, 127 patients (96 men), having a mean+/-SD age of 45+/-20 years, with a wide range in admission diagnoses (medical, surgical, and multiple trauma patients) were prospectively investigated. Severity of critical illness and organ dysfunction were graded by acute physiology and chronic health evaluation (APACHE II) and sequential organ failure assessment (SOFA) scores, respectively. Blood samples were drawn on admission in the ICU to determine pro- and anti-inflammatory cytokines, including tumor necrosis factor (TNF)-alpha, interleukin (IL)-6, IL-8, and IL-10. The main outcome measure was 28-day mortality.
  
  
  RESULTS
  Overall, 88 patients survived and 39 patients died. Univariate logistic regression analysis showed that SOFA, APACHE II, IL-8, IL-6, and IL-10 on admission in the ICU were related to mortality. Multiple logistic regression analysis in the entire cohort of critically ill patients revealed that SOFA (OR=1.341, p<0.001) and IL-6 (OR=1.075, p=0.01) constituted independent outcome predictors. receiver operator characteristics curve analysis showed that SOFA, APACHE II, and IL-6 had the highest area under the curve values. IL-6 correlated with APACHE II (r(s)=0.44, p<0.0001) and SOFA (r(s)=0.40, p<0.0001) scores.
  
  
  CONCLUSIONS
  In mixed ICU patients cytokine concentrations on admission in the ICU represent independent outcome predictors in the presence of disease severity scores.
authors.affiliation: Second Department of Critical Care Medicine, Attikon Hospital, Medical School, University of Athens, 2 Pesmazoglou Street, 14 561 Kifissia, Athens, Greece. idimo@otenet.gr
authors.forename: Ioanna
authors.initials: I
authors.lastname: Dimopoulou
authors.forename: Stylianos
authors.initials: S
authors.lastname: Orfanos
authors.forename: Anastasia
authors.initials: A
authors.lastname: Kotanidou
authors.forename: Olga
authors.initials: O
authors.lastname: Livaditi
authors.forename: Evangellos
authors.initials: E
authors.lastname: Giamarellos-Bourboulis
authors.forename: Chariklia
authors.initials: C
authors.lastname: Athanasiou
authors.forename: Ioanna
authors.initials: I
authors.lastname: Korovesi
authors.forename: Christina
authors.initials: C
authors.lastname: Sotiropoulou
authors.forename: Petros
authors.initials: P
authors.lastname: Kopterides
authors.forename: Ioannis
authors.initials: I
authors.lastname: Ilias
authors.forename: Kyriaki
authors.initials: K
authors.lastname: Kanellakopoulou
authors.forename: Apostolos
authors.initials: A
authors.lastname: Armaganidis
mesh_terms: D000328:Adult; D016638:Critical Illness / Q000401:mortality*; D016207:Cytokines / Q000097:blood*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis
chemical_list: D016207:Cytokines