Diagnosis-dependent relationships between cytokine levels and survival in patients admitted for surgical critical care.
BACKGROUND
Death after trauma, infection, or other critical illness has been attributed to unbalanced inflammation, in which dysregulation of cytokines leads to multiple organ dysfunction and death. We hypothesized that admission cytokine profiles associated with death would differ based on admitting diagnosis.


METHODS
This 5-year study included patients admitted for trauma or surgical intensive care for more than 48 hours at 2 academic, tertiary care hospitals between October 2001 and May 2006. Cytokine analysis for interleukin (IL)-1, -2, -4, -6, -8, -10, -12, interferon-gamma, and tumor necrosis factor (TNF)-alpha was performed using ELISA on specimens drawn within 72 hours of admission. Mann-Whitney U test was used to compare median admission cytokine levels between alive and deceased patients. Relative risks and odds of death associated with admission cytokines were generated using univariate analysis and multivariate logistic regression models, respectively.


RESULTS
There were 1,655 patients who had complete cytokine data: 290 infected, nontrauma; 343 noninfected, nontrauma; and 1,022 trauma. Among infected patients, nonsurvivors had higher median admission levels of IL-2, -8, -10, and granulocyte macrophage-colony stimulating factor; noninfected, nontrauma patients had higher IL-6, -8, and IL-10; and nonsurviving trauma patients had higher IL-4, -6, -8, and TNF-alpha. IL-4 was the most significant predictor of death and carried the highest relative risk of dying in trauma patients, and IL-8 in nontrauma, noninfected patients. In infected patients, no cytokine independently predicted death.


CONCLUSIONS
Cytokine profiles of certain disease states may identify persons at risk of dying and allow for selective targeting of multiple cytokines to prevent organ dysfunction and death.
Hranjec
Tjasa
T
Division of Trauma and Surgical Critical Care, Department of Surgery, University of Virginia, Charlottesville, VA 22908, USA.
Swenson
Brian R
BR
Dossett
Lesly A
LA
Metzger
Rosemarie
R
Flohr
Tanya R
TR
Popovsky
Kimberley A
KA
Bonatti
Hugo J
HJ
May
Addison K
AK
Sawyer
Robert G
RG
D000368:Aged; D015331:Cohort Studies; D003422:Critical Care; D016207:Cytokines / Q000097:blood*; D003953:Diagnosis-Related Groups; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D007239:Infections / Q000097:blood* / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D014947:Wounds and Injuries / Q000097:blood* / Q000401:mortality* / Q000628:therapy
D016207:Cytokines