Serum-induced macrophage activation is related to the severity of septic shock.
BACKGROUND
It seems that a balance between anti and pro-inflammatory responses must be kept to eliminate the pathogen without inducing inflammatory damage in the host. Thus we determined the relation between macrophage activation and the severity and clinical outcome in septic patients.


METHODS
This was a prospective study at a tertiary general intensive care unit. Thirty-three patients admitted with sepsis, severe sepsis or septic shock were included. As a control group, healthy volunteers were included matched to septic patients by age and sex. Peritoneal rat macrophages were cultured with 2% serum from healthy volunteers or from septic patients for determination of phagocytic potential or the capacity to produce cytokines.


RESULTS
TNF and IL1 secretion by macrophages activated with serum from sepsis and severe sepsis patients was higher than with serum from healthy controls. In addition, proinflammatory cytokines released in vitro from macrophages, but not determined directly in the serum from patients, were lower in non-survivor septic patients when compared to survivors. In contrast, IL-10 secretion by macrophages activated with serum from septic patients was higher in nonsurvivors. In the septic shock group we observed a diminution in the phagocytic index compared to sepsis and severe sepsis groups, and the phagocytic index was higher in sepsis survivors.


CONCLUSIONS
Markers of antiinflammation are predominant in more severe types of sepsis suggesting that antiinflammation is related to mortality.
Peck
G
G
Laboratório de Fisiopatologia Experimental, Programa de Pós-Graduação em Ciências da Saúde, Unidade Acadêmica de Ciências da Saúde, Universidade do Extremo Sul Catarinense, SC, Brazil.
Andrades
M
M
Lorenzi
R
R
da Costa
M
M
Petronilho
F
F
Moreira
J C Fonseca
JC
Dal-Pizzol
F
F
Ritter
C
C
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D002478:Cells, Cultured; D016207:Cytokines / Q000097:blood / Q000276:immunology; D006801:Humans; D008262:Macrophage Activation; D017737:Macrophages, Peritoneal / Q000166:cytology / Q000276:immunology; D008875:Middle Aged; D009569:Nitric Oxide / Q000378:metabolism; D010587:Phagocytosis; D011446:Prospective Studies; D051381:Rats; D017208:Rats, Wistar; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000097:blood / Q000276:immunology; D016896:Treatment Outcome
D016207:Cytokines; D009569:Nitric Oxide