title: Several Cytokines and Protein C Levels with the Apache II Scoring System for Evaluation of Patients with Sepsis.
abstract: OBJECTIVE
  We investigated whether determination IL-6, IL-8, IL-1beta and TNF-alpha at baseline, total protein C (PC) levels at time of admission and 48 hours after initiation could complement the Acute Physiology and Chronic Health Evaluation (APACHE) II scoring system to identify patients with sepsis, severe sepsis or septic shock for clinical outcome.
  
  
  METHODS
  The study was carried out prospectively. 60 consecutive patients with sepsis, severe sepsis or septic shock were included. Blood samples were obtained at baseline and 48 hours after initiation. Cytokines and PC levels in plasma were measured with an enzyme-linked immunoabsorbent assay (ELISA). APACHE II score was calculated on admission.
  
  
  RESULTS
  Baseline IL-6 levels and PC levels 48 hours after initiation were predictive of increased mortality (p=0.016, p=0.044 respectively). Baseline IL-6, IL-8 and TNF-alpha baseline levels correlate with the severity of physiologic insult, as determined by the APACHE II score. However, our multiple logistic regression analysis of these did not reveal any predictive value in combination with the APACHE II score.
  
  
  CONCLUSIONS
  Determination of baseline IL-6 and PC 48 hours after initiation were of predictive value for prognostic evaluation of septic patients, but did not significantly increase predictive power of the APACHE scoring system to identify patients with sepsis for fatal clinical outcome.
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey.
authors.forename: Elif Doyuk
authors.initials: ED
authors.lastname: Kartal
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey.
authors.forename: Emine
authors.initials: E
authors.lastname: Karkaç
authors.affiliation: Department of Hematology, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey.
authors.forename: Zafer
authors.initials: Z
authors.lastname: Gülbaş
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey.
authors.forename: Saygın Nayman
authors.initials: SN
authors.lastname: Alpat
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey.
authors.forename: Nurettin
authors.initials: N
authors.lastname: Erben
authors.affiliation: Department of Biostatistics, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey.
authors.forename: Ertuğrul
authors.initials: E
authors.lastname: Colak
keywords: APACHE II; Interleukin 1-beta; Interleukin 6; Interleukin 8; Protein C; Sepsis; Tumor necrosis factor-alpha