Document Detail

The association between mortality rates and decreased concentrations of interleukin-10 and interleukin-1 receptor antagonist in the lung fluids of patients with the adult respiratory distress syndrome.
MedLine Citation:
PMID:  8686976     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: To determine the relation between 1) intra-alveolar concentrations of the proinflammatory cytokines (tumor necrosis factor, interleukin-1 beta, and interleukin-8) and the anti-inflammatory cytokines (interleukin-10 and interleukin-1 receptor antagonist) in patients with early adult respiratory distress syndrome (ARDS) and 2) subsequent patient mortality rates. DESIGN: Prospective cohort study. SETTING: University medical center. PATIENTS: 28 consecutive patients in whom ARDS was prospectively identified during hospitalization and 9 ventilated controls. MEASUREMENTS: Concentrations of proinflammatory cytokines and anti-inflammatory cytokines in bronchoalveolar lavage fluid. RESULTS: The concentrations of proinflammatory and anti-inflammatory cytokines within the alveolar air spaces were significantly elevated in patients with ARDS compared with controls (P = 0.01 for tumor necrosis factor [median, 90 pg/mL (range, 0 to 2500 pg/mL) for patients with ARDS; median, 0 pg/mL (range, 0 to 118 pg/mL) for controls]; P = 0.001 for interleukin-1 beta [median, 179 pg/mL (range, 0 to 2200 pg/mL) for patients with ARDS; median, 0 pg/mL (range, 0 to 80 pg/mL) for controls]; P = 0.0001 for interleukin-8 [median, 628 pg/mL (range, 0 to 4700 pg/mL) for patients with ARDS; median, 0 pg/mL (range, 0 to 278 pg/mL) for controls]; P = 0.0005 for interleukin-10 [median, 100 pg/mL (range, 0 to 1600 pg/mL) for patients with ARDS; median, 0 pg/mL (range, 0 to 50 pg/mL) for controls], and P = 0.002 for interleukin-1 receptor antagonist [median, 820 pg/mL (range, 0 to 18,900 pg/mL) for patients with ARDS; median, 50 pg/mL (range, 0 to 240 pg/mL) for controls]). A highly significant correlation was found between low concentrations of anti-inflammatory cytokines and subsequent patient mortality rates (P = 0.003 for interleukin-10 [median, 120 pg/mL (range, 30 to 1600 pg/mL) for survivors; median, 40 pg/mL (range, 0 to 110 pg/mL) for nonsurvivors]; P = 0.008 for interleukin-1 receptor antagonist [median, 1600 pg/mL (range, 80 to 18,900 pg/mL) for survivors; median, 90 pg/mL (range, 0 to 3400 pg/mL) for nonsurvivors. No significant correlation was found between the concentrations of the proinflammatory cytokines and mortality rates. CONCLUSION: Low concentrations of the anti-inflammatory cytokines interleukin-10 and interleukin-1 receptor antagonist in bronchoalveolar lavage fluid obtained from patients with early ARDS are closely associated with poor prognosis. These findings support the hypothesis that failure to mount a localized intrapulmonary anti-inflammatory response early in the pathogenesis of ARDS contributes to more severe organ injury and worse prognosis. Our findings suggest that augmenting anti-inflammatory cytokine defenses would be a beneficial therapeutic approach to patients with ARDS and other inflammatory diseases.
S C Donnelly; R M Strieter; P T Reid; S L Kunkel; M D Burdick; I Armstrong; A Mackenzie; C Haslett
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Annals of internal medicine     Volume:  125     ISSN:  0003-4819     ISO Abbreviation:  Ann. Intern. Med.     Publication Date:  1996 Aug 
Date Detail:
Created Date:  1996-08-19     Completed Date:  1996-08-19     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0372351     Medline TA:  Ann Intern Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  191-6     Citation Subset:  AIM; IM    
University of Edinburgh, Royal Infirmary, United Kingdom.
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MeSH Terms
Aged, 80 and over
Bronchoalveolar Lavage Fluid / chemistry*
Enzyme-Linked Immunosorbent Assay
Interleukin-1 / metabolism
Interleukin-6 / metabolism
Interleukin-8 / metabolism
Middle Aged
Prospective Studies
Receptors, Interleukin / metabolism*
Receptors, Interleukin-1 / antagonists & inhibitors*
Receptors, Interleukin-10
Respiratory Distress Syndrome, Adult / metabolism*,  mortality*
Tumor Necrosis Factor-alpha / metabolism
Reg. No./Substance:
0/Interleukin-1; 0/Interleukin-6; 0/Interleukin-8; 0/Receptors, Interleukin; 0/Receptors, Interleukin-1; 0/Receptors, Interleukin-10; 0/Tumor Necrosis Factor-alpha

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