High levels of serum macrophage migration inhibitory factor and interleukin 10 are associated with a rapidly fatal outcome in patients with severe sepsis.
OBJECTIVE
The aim of this study was to delineate the association between high macrophage migration inhibitory factor (MIF) and interleukin 10 (IL-10) levels in the early phase of sepsis and rapidly fatal outcome.


METHODS
One hundred and fifty-three adult subjects with the main diagnosis of severe sepsis (including septic shock) admitted directly from the emergency department of two tertiary medical centers and one regional teaching hospital between January 2009 and December 2011, were included prospectively. MIF and IL-10 levels were measured and outcomes were analyzed by Cox regression analysis according to the following outcomes: rapidly fatal outcome (RFO, death within 48 h), late fatal outcome (LFO, death between 48 h and 28 days), and survival at 28 days.


RESULTS
Among the three outcome groups, IL-10 levels were significantly higher in the RFO group (p < 0.001) and no significant differences were seen between the LFO and survivor groups. After Cox regression analysis, each incremental elevation of 1000 pg/ml in both IL-10 and MIF was independently associated with RFO in patients with severe sepsis. Each incremental elevation of 1000 pg/ml in IL-10 increased the RFO risk by a factor of 1.312 (95% confidence interval 1.094-1.575; p=0.003); this was the most significant factor leading to RFO in patients with severe sepsis.


CONCLUSIONS
Patients with RFO exhibited simultaneously high MIF and IL-10 levels in the early phase of severe sepsis. Incremental increases in both IL-10 and MIF levels were associated with RFO in this patient group, and of the two, IL-10 was the most significant factor linked to RFO.
Department of Internal Medicine, Taoyuan General Hospital, Department of Health, Taoyuan, Taiwan.
Tzu-Yi
TY
Chuang
Department of Critical Care Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan.
Hou-Tai
HT
Chang
Departments of Laboratory Medicine and Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, No. 7, Chung-Shan S. Rd., Taipei 100, Taiwan; Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, National Taiwan University College of Medicine, Hsin-Chu, Taiwan.
Kuei-Pin
KP
Chung
Departments of Laboratory Medicine and Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, No. 7, Chung-Shan S. Rd., Taipei 100, Taiwan.
Hui-Shan
HS
Cheng
Department of Communications Management, Ming Chuan University, Taipei, Taiwan.
Chung-Yang
CY
Liu
Center of Tuberculosis Prevention, Taoyuan General Hospital, Department of Health, Taoyuan, Taiwan.
Yen-Chun
YC
Liu
Center of Tuberculosis Prevention, Taoyuan General Hospital, Department of Health, Taoyuan, Taiwan.
Hsiu-Han
HH
Huang
Center of Tuberculosis Prevention, Taoyuan General Hospital, Department of Health, Taoyuan, Taiwan.
Ting-Chen
TC
Chou
Department of Laboratory Medicine, Taoyuan General Hospital, Department of Health, Taoyuan, Taiwan.
Bei-Ling
BL
Chang
Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, National Taiwan University College of Medicine, Hsin-Chu, Taiwan.
Meng-Rui
MR
Lee
Department of Internal Medicine, Taoyuan General Hospital, Department of Health, Taoyuan, Taiwan.
Chou-Jui
CJ
Lin
Department of Internal Medicine, Taoyuan General Hospital, Department of Health, Taoyuan, Taiwan.
Shih-Wei
SW
Lee
Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
Chong-Jen
CJ
Yu
Departments of Laboratory Medicine and Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, No. 7, Chung-Shan S. Rd., Taipei 100, Taiwan. Electronic address: hsporen@ntu.edu.tw.
Po-Ren
PR
Hsueh
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D016753:Interleukin-10 / Q000097:blood*; D008263:Macrophage Migration-Inhibitory Factors / Q000097:blood*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018805:Sepsis / Q000097:blood* / Q000175:diagnosis* / Q000401:mortality*; D012772:Shock, Septic / Q000401:mortality
D008263:Macrophage Migration-Inhibitory Factors; D016753:Interleukin-10
Intensive care units; Interleukin 10; Macrophage migration inhibitory factor; Rapidly fatal outcome; Severe sepsis