title: Immunological characterization of compensatory anti-inflammatory response syndrome in patients with severe sepsis: a longitudinal study*.
abstract: OBJECTIVE
  To perform a complete immunological characterization of compensatory anti-inflammatory response syndrome in patients with sepsis and to explore the relationship between these changes and clinical outcomes of 28-day mortality and secondary infections.
  
  
  METHODS
  Prospective single-center study conducted between April 2011 and December 2012.
  
  
  METHODS
  ICUs from Hospital Universitario San Vicente Fundación at Medellin, Colombia.
  
  
  METHODS
  One hundred forty-eight patients with severe sepsis.
  
  
  METHODS
  None.
  
  
  RESULTS
  At days 0, 1, 3, 5, 10, and 28, we determined the expression of HLA-DR in monocytes and the apoptosis and the proliferation index in T lymphocytes, as well as the levels of tumor necrosis factor-α, interleukin-6, interleukin-1β, interleukin-10, and transforming growth factor-β in both plasma and cell culture supernatants of peripheral blood mononuclear cells. The mean percentage of HLA-DR was 60.7 at enrollment and increased by 0.9% (95% CI, 0.7-1.2%) per day. The mean percentage of CD4 T cells and CD8 T cells AV+/7-AAD- at enrollment was 37.2% and 20.4%, respectively, but it diminished at a rate of -0.5% (95% CI, -0.7% to -0.3%) and -0.3% (95% CI, -0.4% to -0.2%) per day, respectively. Plasma levels of interleukin-6 and interleukin-10 were 290 and 166 pg/mL and decreased at a rate of -7.8 pg/mL (95% CI, -9.5 to -6.1 pg/mL) and -4 pg/mL (95% CI, -5.1 to -2.8 pg/mL) per day, respectively. After controlling for confounders, only sustained plasma levels of interleukin-6 increase the risk of death (hazard ratio 1.003; 95% CI, 1.001-1.006).
  
  
  CONCLUSIONS
  We found no evidence to support a two-phase model of sepsis pathophysiology. However, immunological variables did behave in a mixed and time-dependent manner. Further studies should evaluate changes over time of interleukin-6 plasma levels as a prognostic biomarker for critically ill patients.
authors.affiliation: 1Grupo Inmunovirologia, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia. 2Grupo Académico de Epidemiologia Clínica, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia. 3Departamento de Ciencias Básicas, Facultad Nacional de Salud Pública, Universidad de Antioquia, Medellín, Colombia. 4Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia. 5Departamento de Medicina Interna, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia. 6Unidad de Investigaciones, Hospital Pablo Tobón Uribe, Medellín, Colombia.
authors.forename: Henry G
authors.initials: HG
authors.lastname: Gomez
authors.forename: Sandra M
authors.initials: SM
authors.lastname: Gonzalez
authors.forename: Jessica M
authors.initials: JM
authors.lastname: Londoño
authors.forename: Natalia A
authors.initials: NA
authors.lastname: Hoyos
authors.forename: Cesar D
authors.initials: CD
authors.lastname: Niño
authors.forename: Alba L
authors.initials: AL
authors.lastname: Leon
authors.forename: Paula A
authors.initials: PA
authors.lastname: Velilla
authors.forename: Maria T
authors.initials: MT
authors.lastname: Rugeles
authors.forename: Fabián A
authors.initials: FA
authors.lastname: Jaimes
mesh_terms: D018806:APACHE; D000368:Aged; D017209:Apoptosis; D049109:Cell Proliferation; D015897:Comorbidity; D005260:Female; D006684:HLA-DR Antigens / Q000096:biosynthesis*; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood / Q000276:immunology*; D007362:Intensive Care Units; D007963:Leukocytes, Mononuclear / Q000276:immunology*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D063305:Organ Dysfunction Scores; D011446:Prospective Studies; D044469:Racial Groups; D018805:Sepsis / Q000097:blood / Q000276:immunology*
chemical_list: D006684:HLA-DR Antigens; D018836:Inflammation Mediators