Factors associated with inflammatory cytokine patterns in community-acquired pneumonia.
Raised systemic levels of interleukin (IL)-6 and IL-10 cytokines have been associated with poorer outcome in community-acquired pneumonia. The aim of our study was to identify potential associated factors with increased levels of IL-6, IL-10, or both cytokines. We performed a prospective study of 685 patients admitted to hospital with community-acquired pneumonia. IL-6 and IL-10 were measured in blood in the first 24 h. 30-day mortality increased from 4.8% to 11.4% (p = 0.003) when both cytokines were higher than the median. Independent associated factors with an excess of IL-6 were neurologic disease, confusion, serum sodium < 130 mEq·L⁻¹, pleural effusion, and bacteraemia. The associated factors for an excess of IL-10 were respiratory rate ≥ 30 breaths·min⁻¹, systolic blood pressure < 90 mmHg and glycaemia ≥ 250 mg·dL⁻¹. The independent associated factors for an excess of both cytokines were confusion, systolic blood pressure < 90 mmHg, pleural effusion and bacteraemia. Protective factors were prior antibiotic treatment and pneumococcal vaccination. Different independent factors are related to an excess of IL-6 and IL-10. Confusion, hypotension, pleural effusion and bacteraemia were associated with the inflammatory profile with the highest mortality rate, whereas anti-pneumococcal vaccination and previous antibiotic treatment appeared to be protective factors.
Martínez
R
R
Servicio de Neumología, Hospital Universitario La Fe, Valencia, Spain. rasmartinez@hotmail.com
Menéndez
R
R
Reyes
S
S
Polverino
E
E
Cillóniz
C
C
Martínez
A
A
Esquinas
C
C
Filella
X
X
Ramírez
P
P
Torres
A
A
D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy / Q000401:mortality; D001794:Blood Pressure / Q000187:drug effects; D017714:Community-Acquired Infections / Q000097:blood* / Q000188:drug therapy / Q000401:mortality*; D015897:Comorbidity; D003221:Confusion / Q000097:blood; D005260:Female; D006801:Humans; D016753:Interleukin-10 / Q000097:blood*; D015850:Interleukin-6 / Q000097:blood*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000097:blood / Q000188:drug therapy / Q000401:mortality; D010996:Pleural Effusion / Q000188:drug therapy / Q000401:mortality; D022242:Pneumococcal Vaccines / Q000627:therapeutic use; D018410:Pneumonia, Bacterial / Q000097:blood* / Q000188:drug therapy / Q000401:mortality*; D011446:Prospective Studies; D012119:Respiration / Q000187:drug effects; D012720:Severity of Illness Index; D012964:Sodium / Q000097:blood
D000900:Anti-Bacterial Agents; D015850:Interleukin-6; D022242:Pneumococcal Vaccines; D016753:Interleukin-10; D012964:Sodium