Clinical Significance of Pro-inflammatory Cytokines and Their Correlation with Disease Severity and Blood Coagulation in Septic Patients with Bacterial Co-infection

Abstract

To evaluate the clinical significance of pro-inflammatory cytokines for disease severity and coagulation in septic patients with bacterial co-infection. Methods: A total of 92 patients with sepsis admitted to intensive care unit (ICU) from January 2017 to August 2020 were enrolled and their clinical data were retrospectively analyzed. Fortyseven patients (51.1%) had a single infection by Klebsiella pneumoniae or Acinetobacter baumannii (single-infection group), and 45 patients (48.9%) were infected by both species (co-infection group). We compared the clinical characteristics and disease severity among the 92 patients. Disease severity was defined as ICU stay time and 30-day mortality. Plasma concentrations of pro-inflammatory cytokines and their correlation with disease severity and blood coagulation were analyzed. Results: The 30-day mortality in the co-infection group (35.5%) was significantly higher than in the singleinfection group (19.1%). The levels of IL-6 and TNF-a in the co-infection group were higher than in the single-infection group. Moreover, high levels of IL-6, IL-8, and TNF-a were positively correlated with disease severity (Spearman P value < 0.05). High levels of IL-6 and TNF-a were negatively correlated with the platelet count (Spearman P value < 0.05) and positively correlated with prothrombin time, and plasma levels of fibrin degradation product and D-dimer levels (Spearman P value < 0.05 for all). Conclusion: Septic patients with bacterial co-infection had increased plasma levels of pro-inflammatory cytokines. Furthermore, a positive correlation between high levels of pro-inflammatory cytokines and increased disease severity and depressed blood coagulation function for septic patients with co-infection was identified.

Higher D‐dimer and activated partial thromboplastin time are poor prognostic factors in patients with peritoneal dialysis‐related peritonitis

“…DD increases in patients after infection [19,20]. Elevated DD correlated with high levels of CRP, TNFα, and IL-6 after bacterial infection and resulted in adverse outcomes [8,21]. Bacterial elements, such as endotoxin, stimulate the inflammatory response via activation of cytokine-mediated procoagulant effects on endothelial cells.…”

Successful treatment of acute respiratory distress syndrome caused by hypervirulent Klebsiella pneumoniae with extracorporeal membrane oxygenation and continuous renal replacement therapy: A case report and literature review

“…The patient's kidney functions gradually recovered and RRT was discontinued on the 25th day. Like COVID-19 infection, inflammatory mediators play an important role in sepsis and septic shock, exacerbating organ damage and correlating with disease severity ( 64 ). Many clinical strategies have been attempted to reduce inflammatory damage.…”

Elevated plasma D-dimer levels are associated with the poor prognosis of critically ill children

“…A prospective emergency department cohort study reported that compared to patients with abnormal D-dimer levels, patients with normal D-dimer levels presented a lower risk of 30-day mortality (18). Furthermore, the increased D-dimer levels were associated with higher production of TNF-α, IL-6, and IL-8 (19,20) and indicated the activation of coagulation and fibrinolysis to develop to disseminated intravascular coagulation (DIC), especially in sepsis (20). All the undesirable biological processes may significantly increase the incidence of multi-system organ failure (MOF) (19), leading to high in-hospital mortality of critically ill children.…”