title: Blister fluid and serum cytokine levels in severe sepsis in humans reflect skin dysfunction.
abstract: BACKGROUND
  Knowledge of sepsis-related end-organ inflammation in vivo is limited. We investigated the cytokine response in skin and in serum in sepsis and its relation to multiorgan failure (MOF) and survival.
  
  
  METHODS
  Cytokines were analysed in serum and in suction blister fluid of intact skin of 44 patients with severe sepsis and 15 healthy controls. Blister fluid and serum samples were collected within 48 h of the first sepsis-induced organ failure. This is a substudy of a larger follow-up study on wound healing in sepsis.
  
  
  RESULTS
  Cytokine levels were higher in patients with sepsis vs. controls (interleukin [IL]-10, blisters: 65.9 vs. 4.3 pg/ml, P < 0.001, serum: 25.7 vs. 4.5 pg/ml, P = 0.004; IL-6, blisters: 41.9 vs. 0.03 pg/ml, P < 0.001, serum: 45.5 vs. 2.1 pg/ml, P < 0.001). Patients with MOF had higher levels of IL-10 (116.4 vs. 21.3 pg/ml, P = 0.015), IL-4 (0.7 vs. 0.07 pg/ml, P = 0.013) and basic fibroblast growth factor (bFGF) (25.9 vs. 9.5 pg/ml, P = 0.027) in blister fluid than patients without MOF. In blister fluid, survivors had lower levels of IL-10 (43.3 vs. 181.9 pg/ml, P = 0.024) and bFGF (15.8 vs. 31.9 pg/ml, P = 0.006) than non-survivors. In serum, survivors had higher levels of vascular endothelial growth factor (VEGF) (152.2 vs. 14.7 pg/ml, P = 0.012) and lower levels of IL-6 (38.5 vs. 91.1 pg/ml, P = 0.011) than non-survivors. The blister fluid levels of bFGF, TNF and VEGF did not correlate with the serum levels.
  
  
  CONCLUSIONS
  Cytokine responses in skin blister fluid in patients with sepsis differed from those in healthy controls.
authors: Department of Anesthesiology, Division of Intensive Care Medicine, Oulu University Hospital, Oulu, Finland.|Department of Surgery, Oulu University Hospital, Oulu, Finland.|Medical Research Center, Oulu University Hospital, Oulu, Finland.|Research Group of Surgery, Anesthesiology and Intensive Care Medicine, University of Oulu, Oulu, Finland.
authors: M
authors: M
authors: Koskela
authors: Department of Anesthesiology, Division of Intensive Care Medicine, Oulu University Hospital, Oulu, Finland.|Department of Surgery, Oulu University Hospital, Oulu, Finland.|Medical Research Center, Oulu University Hospital, Oulu, Finland.|Research Group of Surgery, Anesthesiology and Intensive Care Medicine, University of Oulu, Oulu, Finland.
authors: T I
authors: TI
authors: Ala-Kokko
authors: Department of Anesthesiology, Division of Intensive Care Medicine, Oulu University Hospital, Oulu, Finland.|Medical Research Center, Oulu University Hospital, Oulu, Finland.|Research Group of Surgery, Anesthesiology and Intensive Care Medicine, University of Oulu, Oulu, Finland.
authors: F
authors: F
authors: Gäddnäs
authors: Institute of Biomedicine and Biocenter of Oulu, University of Oulu, Oulu, Finland.|Clinical Research Center, University of Oulu, Oulu, Finland.
authors: K-H
authors: KH
authors: Herzig
authors: Institute of Biomedicine and Biocenter of Oulu, University of Oulu, Oulu, Finland.
authors: T
authors: T
authors: Karhu
authors: Department of Dermatology, Oulu University Hospital, Oulu, Finland.
authors: A
authors: A
authors: Oikarinen
authors: Department of Anesthesiology, Division of Intensive Care Medicine, Oulu University Hospital, Oulu, Finland.|Department of Surgery, Oulu University Hospital, Oulu, Finland.|Institute of Biomedicine and Biocenter of Oulu, University of Oulu, Oulu, Finland.|Clinical Research Center, University of Oulu, Oulu, Finland.
authors: V
authors: V
authors: Koivukangas
mesh_terms: D000368:Aged; D001768:Blister / Q000276:immunology*; D016207:Cytokines / Q000032:analysis*; D006801:Humans; D006854:Hydrocortisone / Q000627:therapeutic use; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000276:immunology; D018805:Sepsis / Q000188:drug therapy / Q000276:immunology* / Q000401:mortality; D012867:Skin / Q000276:immunology*; D014945:Wound Healing / Q000502:physiology*
chemical_list: D016207:Cytokines; D006854:Hydrocortisone