Coincidence of pro- and anti-inflammatory responses in the early phase of severe sepsis: Longitudinal study of mononuclear histocompatibility leukocyte antigen-DR expression, procalcitonin, C-reactive protein, and changes in T-cell subsets in septic and postoperative patients

Tschaikowsky, K.; Hedwig-Geissing, Monika; Schiele, A.; Bremer, Frank; Schywalsky, M.; Schüttler, J.

doi:10.1097/00003246-200205000-00010

Cited by 157 publications

(125 citation statements)

References 31 publications

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“…Evaluations of infected patients showed no increased levels of C-reactive protein, contrary to what was suggested by other authors. 38, [49][50][51][52] Our data cannot support the suggestion that C-reactive protein is a marker for infection. No correlation was observed between C-reactive protein values and the severity of infection or organ dysfunction level.…”

Section: Discussionmentioning

confidence: 61%

Effects of single dose of dexamethasone on patients with systemic inflammatory response

2006

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CONTEXT AND OBJECTIVE: Systemic inflammatory response syndrome (SIRS) is a very common condition among critically ill patients. SIRS, sepsis, septic shock and multiple organ dysfunction syndrome (MODS) can lead to death. Our aim was to investigate the efficacy of a single dose of dexamethasone for blocking the progression of systemic inflammatory response syndrome. DESIGN AND SETTING: Prospective, randomized, double-blind, single-center study in a postoperative intensive care unit (Surgical Support Unit) at Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo. METHODS: The study involved 29 patients with SIRS. All eligible patients were prospectively randomized to receive either a single dose of 0.2 mg/kg of dexamethasone or placebo, after SIRS was diagnosed. The patients were monitored over a seven-day period using Sequential Organ Failure Assessment score (SOFA). RESULTS: The respiratory system showed an improvement on the first day after dexamethasone was administered, demonstrated by the improved PaO2/FiO2 ratio (p < 0.05). The cardiovascular system of patients requiring vasopressor therapy also improved over the first two days, with a better evolution in the dexamethasone group (p < 0.05). Non-surviving patients presented higher lactate assays than did survivors (p < 0.05) during this period. CONCLUSIONS: Dexamethasone enhanced the effects of vasopressor drugs and evaluation of the respiratory system showed improvements (better PaO2/FiO2 ratio), one day after its administration. Despite these improvements, the single dose of dexamethasone did not block the evolution of SIRS.

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Section: Discussionmentioning

confidence: 61%

Effects of single dose of dexamethasone on patients with systemic inflammatory response

2006

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“…It needs to be stressed that a simple measurement of circulating cytokines, regardless of how many are measured, cannot serve as a definite assessment of the individual inflammatory response (proinflammatory vs anti-inflammatory). Given that late CARS immunosuppression is also defined by the functional defects in peritoneal/splenic macrophages (45)(46)(47) and MHC class II expression (48,49), additional studies of the cellular component are required to support the suggested hypothesis that immunosuppression primarily consists of the failure of macrophages to respond to stimuli. Our previous findings showed that macrophages from moribund mice (chronic sepsis) stimulated by TLR 2 and 4 agonists released less IL-6 compared with cells isolated from matching healthy mice (23).…”

Section: Discussionmentioning

confidence: 99%

Chronic Sepsis Mortality Characterized by an Individualized Inflammatory Response

Osuchowski

Welch

Yang³

et al. 2007

The Journal of Immunology

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Late mortality in septic patients often exceeds the lethality occurring in acute sepsis, yet the immunoinflammatory alterations preceding chronic sepsis mortality are not well defined. We studied plasma cytokine concentrations preceding late septic deaths (days 6–28) in a murine model of sepsis induced by polymicrobial peritonitis. The late prelethal inflammatory response varied from a virtually nonexistent response in three of 14 to a mixed response in eight of 14 mice to the concurrent presence of nearly all measured cytokines, both proinflammatory and anti-inflammatory in three of 14 mice. In responding mice a consistent prelethal surge of plasma MIP-2 (1.6 vs 0.12 ng/ml in survivors; mean values), MCP-1 (2.0 vs 1.3 ng/ml), soluble TNF receptor type I (2.5 vs 0.66 ng/ml), and the IL-1 receptor antagonist (74.5 vs 3.3 ng/ml) was present, although there were infrequent increases in IL-6 (1.9 vs 0.03 ng/ml) and IL-10 (0.12 vs 0.04 ng/ml). For high mobility group box 1, late mortality was signaled by its decrease in plasma levels (591 vs 864 ng/ml). These results demonstrate that impeding mortality in the chronic phase of sepsis may be accurately predicted by plasma biomarkers, providing a mechanistic basis for individualized therapy. The pattern of late prelethal responses suggest that the systemic inflammatory response syndrome to compensatory anti-inflammatory response syndrome transition paradigm fails to follow a simple linear pattern.

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“…Up to now, the decrease of mHLA-DR expression has mainly been assessed as a predictor of septic complications after trauma, surgery, or pancreatitis (28,(92)(93)(94)(95)(96)(97)(98). In these studies, low levels of mHLA-DR (<40% of positive monocytes, normal >90%) were observed in patients who subsequently developed nosocomial infections.…”

Section: Mhla-dr Expression and Clinical Studymentioning

confidence: 99%

“…On the other hand, low mHLA-DR has also been shown to be predictive of adverse outcome in different groups of critically ill patients (97,102,103). We recently observed that burn patients rapidly presented with decreased mHLA-DR expression in the first day after burn, and that this expression subsequently increased in patients who survived but remained low in nonsurvivors (101).…”

Section: Mhla-dr Expression and Clinical Studymentioning

confidence: 99%

Monitoring Immune Dysfunctions in the Septic Patient: A New Skin for the Old Ceremony

Monneret

Venet

Pachot

et al. 2008

Mol Med

302

323

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Coincidence of pro- and anti-inflammatory responses in the early phase of severe sepsis: Longitudinal study of mononuclear histocompatibility leukocyte antigen-DR expression, procalcitonin, C-reactive protein, and changes in T-cell subsets in septic and postoperative patients

Abstract: Decreases in monocytic HLA-DR expression occurred simultaneously with signs of hyperinflammation as early as the onset of severe sepsis and usually developed in opposite directions than inflammatory markers and sepsis severity scores.

Cited by 157 publications

References 31 publications

Effects of single dose of dexamethasone on patients with systemic inflammatory response

Effects of single dose of dexamethasone on patients with systemic inflammatory response

Chronic Sepsis Mortality Characterized by an Individualized Inflammatory Response

Monitoring Immune Dysfunctions in the Septic Patient: A New Skin for the Old Ceremony

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