Cytokine profiles in sepsis have limited relevance for stratifying patients in the emergency department: a prospective observational study.
BACKGROUND
Morbidity, mortality and social cost of sepsis are high. Previous studies have suggested that individual cytokines levels could be used as sepsis markers. Therefore, we assessed whether the multiplex technology could identify useful cytokine profiles in Emergency Department (ED) patients.


METHODS
ED patients were included in a single tertiary-care center prospective study. Eligible patients were >18 years and met at least one of the following criteria: fever, suspected systemic infection, ≥ 2 systemic inflammatory response syndrome (SIRS) criteria, hypotension or shock. Multiplex cytokine measurements were performed on serum samples collected at inclusion. Associations between cytokine levels and sepsis were assessed using univariate and multivariate logistic regressions, principal component analysis (PCA) and agglomerative hierarchical clustering (AHC).


RESULTS
Among the 126 patients (71 men, 55 women; median age: 54 years [19-96 years]) included, 102 had SIRS (81%), 55 (44%) had severe sepsis and 10 (8%) had septic shock. Univariate analysis revealed weak associations between cytokine levels and sepsis. Multivariate analysis revealed independent association between sIL-2R (p = 0.01) and severe sepsis, as well as between sIL-2R (p = 0.04), IL-1β (p = 0.046), IL-8 (p = 0.02) and septic shock. However, neither PCA nor AHC distinguished profiles characteristic of sepsis.


CONCLUSIONS
Previous non-multiparametric studies might have reached inappropriate conclusions. Indeed, well-defined clinical conditions do not translate into particular cytokine profiles. Additional and larger trials are now required to validate the limited interest of expensive multiplex cytokine profiling for staging septic patients.
Emergency Department, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France.
Virginie
V
Lvovschi
Laurent
L
Arnaud
Christophe
C
Parizot
Yonathan
Y
Freund
Gaëlle
G
Juillien
Pascale
P
Ghillani-Dalbin
Mohammed
M
Bouberima
Martin
M
Larsen
Bruno
B
Riou
Guy
G
Gorochov
Pierre
P
Hausfater
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001424:Bacterial Infections / Q000097:blood / Q000150:complications; D016207:Cytokines / Q000097:blood*; D004636:Emergency Service, Hospital; D005260:Female; D005334:Fever / Q000097:blood / Q000150:complications; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D025341:Principal Component Analysis; D011446:Prospective Studies; D018805:Sepsis / Q000097:blood* / Q000150:complications / Q000382:microbiology / Q000401:mortality; D012772:Shock, Septic / Q000097:blood / Q000150:complications / Q000382:microbiology; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood / Q000150:complications / Q000382:microbiology; D055815:Young Adult
D016207:Cytokines