| Mortality in Patients With Septic Shock Correlates With Anti-Inflammatory But not Proinflammatory Immunomodulatory Molecules. | |
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MedLine Citation:
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PMID: 21464065 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
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Background: Mortality in patients with septic shock remains unacceptably high and the attempts to antagonize certain proinflammatory cytokines based on the results of animal model studies have failed to improve survival rates. The objective of this article is to examine the pro-/anti-inflammatory cytokine balance in patients with septic shock and its connection with mortality. Methods: Serum levels of proinflammatory cytokines (tumor necrosis factor-α [TNF-α], interleukin 1β [IL-1β], interferonγ [IFN-γ], and IL-6) and soluble cytokine antagonists (soluble TNF receptor I [sTNF-RI], sTNF-RII, and IL-1Ra) were determined on admission to the intensive care unit (ICU) and 3, 7, 14, and 28 days later in 52 patients with septic shock and in 36 healthy controls. Specific sandwich enzyme-linked immunosorbent assay (ELISA) was used for all determinations. Results: Serum levels of most of the pro- and anti-inflammatory molecules examined (TNF-α, IL-6, sTNF-RI, sTNF-RII, and IL-1 receptor agonist [IL-1Ra]) were significantly elevated on admission and during the 28-day observation period in patients when compared to controls. Notably, the anti-inflammatory mediators sTNF-RI, sTNF-RII, and IL-1Ra were better predictors of mortality. Receiver-operating characteristic (ROC) analysis revealed that sTNF-RI or sTNF-RII concentrations over 2767 or 4619 pg/mL, respectively, determined a high risk of death (sensitivity: 100%-100%, specificity: 57.1%-71.4%, area under the curve [AUC] 0.759-0.841, respectively), whereas IL-1Ra concentrations below 7033 pg/mL determined a high probability of survival (sensitivity: 60%, specificity: 100%, AUC 0.724). In addition, IFN-γ levels were significantly higher in survivors than in controls during the initial 2 weeks of observation. Conclusions: Our data show that serum cytokine disturbance patterns have prognostic significance in patients with septic shock admitted to the ICU. The pattern, defined by an early response to continuously elevated anti-inflammatory cytokine serum levels, is associated with an enhanced risk of a fatal outcome for patients. |
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Authors:
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Raúl de Pablo; Jorge Monserrat; Eduardo Reyes; David Diaz-Martin; Manuel Rodriguez Zapata; Fernando Carballo; Antonio de la Hera; Alfredo Prieto; Melchor Alvarez-Mon |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Journal of intensive care medicine Volume: 26 ISSN: 1525-1489 ISO Abbreviation: J Intensive Care Med Publication Date: 2011 Mar-Apr |
Date Detail:
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Created Date: 2011-04-05 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8610344 Medline TA: J Intensive Care Med Country: United States |
Other Details:
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Languages: eng Pagination: 125-32 Citation Subset: IM |
Affiliation:
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Intensive Care Unit, Hospital Universitario Principe de Asturias, Alcala de Henares, Madrid, Spain, Laboratory of Immune System Diseases and Oncology, Department of Medicine, University of Alcala, Madrid, Spain. raul.depablo@uah.es. |
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