title: Plasma cytokine levels predict response to corticosteroids in septic shock.
abstract: OBJECTIVE
  To investigate if plasma cytokine concentrations predict a beneficial response to corticosteroid treatment in septic shock patients.
  
  
  METHODS
  A cohort of septic shock patients in whom a panel of 39 cytokines had been measured at baseline (n = 363) was included. Patients who received corticosteroids were propensity score matched to non-corticosteroid-treated patients. An optimal threshold to identify responders to corticosteroid treatment for each cytokine was defined as the concentration above which the odds ratio for 28-day survival between corticosteroid- and non-corticosteroid-treated patients was highest.
  
  
  RESULTS
  Propensity score matching partitioned 165 patients into 61 sets; each set contained matched corticosteroid- and non-corticosteroid-treated patients. For 13 plasma cytokines threshold concentrations were found where the odds ratio for survival between corticosteroid- and non-corticosteroid-treated patients was significant (P < 0.05). CD40 ligand was associated with the highest odds ratio and identified 21 % of the patients in the propensity score matched cohort as responders to corticosteroid treatment. Combinations of triplets of cytokines with a significant odds ratio, using the thresholds identified above, were tested to find a higher proportion of responders. IL3, IL6, and CCL4 identified 50 % of the patients in the propensity score matched cohort as responders to corticosteroid treatment. The odds ratio for 28-day survival was 19 (95 % CI 3.5-140, P = 0.02) with a concentration above threshold for a least one of these cytokines.
  
  
  CONCLUSIONS
  Plasma concentration of selected cytokines is a potential predictive biomarker to identify septic shock patients that may benefit from treatment with corticosteroids.
authors.affiliation: Centre for Heart Lung Innovation (HLI), University of British Columbia, Vancouver, Canada. peter.bentzer@med.lu.se.|Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. peter.bentzer@med.lu.se.|Department of Anesthesia and Intensive Care, Helsingborg Hospital, Helsingborg and Lund University, Lund, Sweden. peter.bentzer@med.lu.se.|Department of Anesthesiology and Intensive Care, Helsingborg Hospital, 251 87, Helsingborg, Sweden. peter.bentzer@med.lu.se.
authors.forename: Peter
authors.initials: P
authors.lastname: Bentzer
authors.affiliation: Centre for Heart Lung Innovation (HLI), University of British Columbia, Vancouver, Canada.|Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
authors.forename: Chris
authors.initials: C
authors.lastname: Fjell
authors.affiliation: Centre for Heart Lung Innovation (HLI), University of British Columbia, Vancouver, Canada.|Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
authors.forename: Keith R
authors.initials: KR
authors.lastname: Walley
authors.affiliation: Centre for Heart Lung Innovation (HLI), University of British Columbia, Vancouver, Canada.|Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
authors.forename: John
authors.initials: J
authors.lastname: Boyd
authors.affiliation: Centre for Heart Lung Innovation (HLI), University of British Columbia, Vancouver, Canada.|Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
authors.forename: James A
authors.initials: JA
authors.lastname: Russell
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000368:Aged; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D016207:Cytokines / Q000097:blood*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012121:Respiration, Artificial; D012772:Shock, Septic / Q000097:blood* / Q000401:mortality; D014662:Vasoconstrictor Agents / Q000627:therapeutic use; D014667:Vasopressins
chemical_list: D000305:Adrenal Cortex Hormones; D015415:Biomarkers; D016207:Cytokines; D014662:Vasoconstrictor Agents; D014667:Vasopressins
keywords: Corticosteroids; Cytokines; Predictive biomarker; Propensity score matching; Septic shock