Plasma pro- and anti-inflammatory cytokine levels and outcome prediction in unselected critically ill patients.
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.
Dimopoulou
Ioanna
I
Second Department of Critical Care Medicine, Attikon Hospital, Medical School, University of Athens, 2 Pesmazoglou Street, 14 561 Kifissia, Athens, Greece. idimo@otenet.gr
Orfanos
Stylianos
S
Kotanidou
Anastasia
A
Livaditi
Olga
O
Giamarellos-Bourboulis
Evangellos
E
Athanasiou
Chariklia
C
Korovesi
Ioanna
I
Sotiropoulou
Christina
C
Kopterides
Petros
P
Ilias
Ioannis
I
Kanellakopoulou
Kyriaki
K
Armaganidis
Apostolos
A
D000328:Adult; D016638:Critical Illness / Q000401:mortality*; D016207:Cytokines / Q000097:blood*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis
D016207:Cytokines