title: A combined score of pro- and anti-inflammatory interleukins improves mortality prediction in severe sepsis.
abstract: Identification of patients at increased risk of death is dramatically important in severe sepsis. Cytokines have been widely assessed as potential biomarkers in this disease, but none of the cytokines studied has evidenced a sufficient specificity or sensitivity to be routinely employed in clinical practice. In this pilot study, we profiled 17 immune mediators in the plasma of 29 consecutively recruited patients with severe sepsis or septic shock, during the first 24h following admission to the ICU, by using a Bio-Plex Human Cytokine 17-Plex Panel (Bio-Rad). Patients were 66.1year old in average. Twelve patients of our cohort died during hospitalization at the ICU, eight of them in the first 72h due to multiorganic dysfunction syndrom (MODS). Levels in plasma of three pro-inflammatory mediators (IL-6, IL-8, MCP-1) and of an immunosuppressive one (IL-10) were higher in those patients with fatal outcome. We developed a combined score with those cytokines showing to better predict mortality in our cohort based on the results of Cox regression analysis. This way, IL-6, IL-8 and IL-10 were included in the score. Patients were split into two groups based on the percentile 75 (P75) of the plasma levels of these three interleukins. Those patients showing at least one interleukin value higher than P75 were given the value "1". Those patients showing IL-6, IL-8, IL-10 levels below P75 were given the value "0". Hazard ratios for mortality at day 3 and day 28th obtained with the combined score were 2-3-fold higher than those obtained with the individual interleukins values. In conclusion, we have described a combined cytokine score associated with a worse outcome in patients with sepsis, which may represent a new avenue to be explored for guiding treatment decisions in this disease.
authors.affiliation: Critical Care Medicine Service, Hospital Clínico Universitario-SACYL/SEMICYUC, Avda Ramón y Cajal 3, 47005 Valladolid, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Andaluz-Ojeda
authors.forename: Felipe
authors.initials: F
authors.lastname: Bobillo
authors.forename: Verónica
authors.initials: V
authors.lastname: Iglesias
authors.forename: Raquel
authors.initials: R
authors.lastname: Almansa
authors.forename: Lucía
authors.initials: L
authors.lastname: Rico
authors.forename: Francisco
authors.initials: F
authors.lastname: Gandía
authors.forename: Salvador
authors.initials: S
authors.lastname: Resino
authors.forename: Eduardo
authors.initials: E
authors.lastname: Tamayo
authors.forename: Raul Ortiz
authors.initials: RO
authors.lastname: de Lejarazu
authors.forename: Jesús F
authors.initials: JF
authors.lastname: Bermejo-Martin
mesh_terms: D000368:Aged; D000893:Anti-Inflammatory Agents / Q000276:immunology*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D018836:Inflammation Mediators / Q000276:immunology*; D007378:Interleukins / Q000276:immunology*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012044:Regression Analysis; D018805:Sepsis / Q000276:immunology* / Q000401:mortality*; D013030:Spain / Q000453:epidemiology
chemical_list: D000893:Anti-Inflammatory Agents; D018836:Inflammation Mediators; D007378:Interleukins