| Duration and Magnitude of Hypotension and Monocyte Deactivation in Patients With Community-Acquired Pneumonia. | |
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MedLine Citation:
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PMID: 22080961 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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PURPOSE:: To examine the relationship of duration and magnitude of arterial hypotension to subsequent cellular immune suppression and cytokinemia in patients hospitalized with community-acquired pneumonia (CAP). METHODS:: We studied an observational cohort of 525 subjects hospitalized after presenting to the Emergency Department with radiographic and clinical signs of CAP. We compared the duration and magnitude of hypotension, using the cardiovascular Sequential Organ Failure Assessment subscore (CV SOFA), to day 3 monocyte expression of human leukocyte antigen-DR (mHLA-DR), a previously validated marker of cellular immune suppression. RESULTS:: A significant association of CV SOFA with decreased mHLA-DR expression was present in univariate analysis (p<0.001) and persisted after adjustment for illness severity and other covariates (p=0.01). With CV SOFA separated into components of magnitude and duration, after covariate adjustment only duration was associated with day 3 mHLA-DR expression (p=0.03). Levels of key pro-and anti-inflammatory cytokines (interleukin-6, interleukin-10, tumor necrosis factor) increased with hypotension exposure, and were also associated with mHLA-DR expression. CONCLUSIONS:: In patients admitted with CAP, arterial hypotension over the first three days is associated with markers of monocyte deactivation. The duration of exposure to hypotension may be more important than the magnitude, and monocyte deactivation correlates with interleukin-6 and interleukin-10 release. These results suggest that persistent hypotension might contribute to immunosuppression following septic shock. |
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Authors:
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Peter M Simon; Russell L Delude; Minjae Lee; Lan Kong; Lynda J Guzik; David T Huang; Derek C Angus; John A Kellum; |
Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-10-6 |
Journal Detail:
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Title: Shock (Augusta, Ga.) Volume: - ISSN: 1540-0514 ISO Abbreviation: - Publication Date: 2011 Oct |
Date Detail:
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Created Date: 2011-11-14 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9421564 Medline TA: Shock Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
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1Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine; School of Medicine 2Department of Pathology, School of Medicine; 3Department of Biostatistics, Graduate School of Public Health; 4Department of Emergency Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15261. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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