Patterns of cytokines, plasma endotoxin, plasminogen activator inhibitor, and acute-phase proteins during the treatment of severe sepsis in humans

Dofferhoff, A. S. M.; Bom, Vjj; Devrieshospers, Hg; Vaningen, J; Vandermeer, J; Hazenberg, Bouke P. C.; Mulder, P. O. M.; Weits, J

doi:10.1097/00003246-199202000-00007

Cited by 179 publications

(90 citation statements)

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“…This is in agreement with the study of Leclerc [1]. Other clinical studies on septic shock patients [7,19], burn patients [15,20], and experimental studies [13], have presented positive correlations between CRP or other acute phase proteins and survival. CRP has been demonstrated to bind to damaged tissue in vivo.…”

Section: Discussionsupporting

confidence: 90%

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Relation between cytokines and routine laboratory data in children with septic shock and purpura

et al. 1994

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Abstract.Objective: To establish the relation between routine laboratory data (lactate, fibrinogen, CRP) and cytokines (TNF, IL-1 and -6) and to estimate their prognostic value in pediatric patients with severe infectious purpura on admission.Design: Prospective study. Setting." Pediatric intensive care unit (PICU).Patients: 17 children aged 5-172 months (median 46) were hospitalized in our PICU in 1989-90 with severe infectious purpura. Neisseria meningitidis was isolated in 15 children and Haemophilus influenzae in two. The patients were divided into 3 groups: non-shock, shock and severe shock leading to death. Shock was defined by standard criteria.Measurements: Arterial blood was sampled for lactate, CRP, fibrinogen, TNF, and IL-1 and -6 on admission. The PRISM (pediatric risk of morality)-score was recorded.Methods." Statistical analysis was performed with the Student's t-test using the logarithmic values of the cytokine concentration, and Spearman correlation analysis.Results." According to the shock criteria, 9 patients were in shock of whom 4 did not survive. Significant differences existed between the 3 groups concerning lactate, TNF, and IL-6. Fibrinogen, CRP, IL-1, and PRISM-score discriminated only between survivors and non-survivors. A highly significant correlation existed between cytokines, the PRISM-score and lactate (TNF: r = 0.69, IL-I: r --0.56, IL-6: r = 0.65, PRISM: r ---0.65). A significant inverse correlation existed between cytokines and CRP (TNF: r=-0.55, IL-I: r=-0.64, and IL-6: r = -0.56), and IL-6 and fibrinogen (r = -0.65). Conclusion:These results show a significant correlation between cytokines and lactate, and lactate, TNF and IL-6 are closely associated with the severity of septic shock with purpura in children.

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Section: Discussionsupporting

confidence: 90%

“…Most of the studies regarding lactate in critically ill patients are in agreement with these results [7,17,18]. However in a recently published study no significant difference in lactate was found between survivors and nonsurvivors in septic patients [19].…”

Section: Discussionsupporting

confidence: 53%

Relation between cytokines and routine laboratory data in children with septic shock and purpura

et al. 1994

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“…Both propofol [13,15,16] and midazolam [12,17] have been shown to inhibit immune function, and if used to sedate critically ill patients for long periods, may further compromise an already depressed immune response. IL-1b, TNF-a, IL-6 and IL-8 are pro-inflammatory cytokines produced by monocytes and macrophages and are central mediators of the host response to injury, infection and inflammation [5,7,9]. IL-8 is a potent chemo-attractant and neutrophil-activating agent and has been implicated in acute lung injury [7].…”

Section: Discussionmentioning

confidence: 99%

“…The potent immunoregulatory cytokines interleukin-2 (IL-2) and interferon-g (IFN-g ) are crucial for the development of Th1 subset of T lymphocytes that are responsible for cellmediated immunity [3]. Alterations in pro-inflammatory cytokine production have been implicated in the pathophysiology of systemic inflammatory response syndrome (SIRS) [4], septic shock [5], acute respiratory distress syndrome (ARDS) [6,7], multiple organ dysfunction syndrome (MODS) [8], multiple trauma [9] and cancer [10]. Immunosuppression after major trauma results from T-cell dysfunction and is characterised by impaired synthesis of IL-2 and IFN-g [11].…”

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confidence: 99%

The immunomodulatory effects of prolonged intravenous infusion of propofol versus midazolam in critically ill surgical patients

Helmy

Al‐Attiyah

2001

Anaesthesia

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Both propofol and midazolam are known to inhibit immune function. The aim of this study was to investigate cytokine production in critically ill surgical patients as early markers of immune response to prolonged infusion of propofol and midazolam. The study enrolled 40 elective patients who were to receive long‐term sedation for more than 2 days. Patients were randomly allocated to one of two equally sized groups. Central venous blood samples for measurement of interleukin‐1β (IL‐1β), interleukin‐2 (IL‐2), interleukin‐6 (IL‐6), interleukin‐8 (IL‐8), tumour necrosis factor‐α (TNF‐α) and interferon‐γ (IFN‐γ) were drawn prior to the start and after 48 h of infusion. After 48 h, propofol caused significant increases in IL‐1β (24%), IL‐6 (23%) and TNF‐α (4.8 times) levels, while midazolam caused significant decreases in IL‐1β (21%), IL‐6 (21%) and TNF‐α (19%). Both agents caused significant decreases in IL‐8 levels (propofol: 30%, midazolam: 48%, p < 0.05). Propofol caused significant decreases in IL‐2 levels (68%, p < 0.001) but increases in IFN‐γ (30%, p < 0.05), whereas there was no significant change with midazolam compared with the pre‐infusion level. In conclusion, during 48 h of continuous infusion, propofol stimulated, while midazolam suppressed, the production of the pro‐inflammatory cytokines IL‐1β, IL‐6 and TNF‐α, and both caused suppression of IL‐8 production. Propofol inhibited IL‐2 production and stimulated IFN‐γ production, whereas midazolam failed to do so. Therefore, sedative agents may have clinical implications in high‐risk and immunocompromised patients.

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“…Cytokines have been demonstrated to be important mediators of the immuno-inflammatory response to injury and infection, and seem to be directly involved in the symptomatology of sepsis, multiorgan failure and septic shock [7][8][9]. The most important cytokines in this regard are interleukin (IL)-1a, IL-1b, IL-2, IL-4, IL-6, tumour necrosis factor-a (TNF-a) and interferon-g (IFN-g).…”

mentioning

confidence: 99%

The effect of anaesthesia and surgery on plasma cytokine production

1999

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SummaryThe aim of this study was to investigate cytokine production in response to anaesthesia [total intravenous anaesthesia (TIVA) with propofol, sufentanil and atracurium] and surgery (laparoscopic vs. open cholecystectomy). Forty adult patients, ASA I-II, undergoing elective laparoscopic (group 1) or open (group 2) cholecystectomy were studied. Venous blood samples for measurement of interleukin (IL)-1b, IL-2, IL-4, IL-6, tumour necrosis factor-a (TNF-a) and interferon-g (IFN-g) were taken before the induction of anaesthesia, pre-incisionaly, at the end of anaesthesia and surgery and 24-h postoperatively. Pre-incisionaly, in both groups, IL-1b, IL-4, IL-6, TNF-a and IFN-g did not show a significant change, whereas IL-2 showed a significant decrease (p < 0.005 in group 1 and p < 0.001 in group 2) compared with pre-induction levels. By the end of anaesthesia and surgery, IL-1b, IL-2, IL-4, IL-6 and TNF-a showed a significant increase in group 2 (p < 0.005 for IL-1b, IL-2 and IL-4, and p < 0.05 for IL-6 and TNF-a); while in group 1, only IL-2 showed a significant increase (p < 0.01) and IFN-g showed a significant decrease (p < 0.05) compared with pre-incisional levels. By 24-h postoperatively, IL-1b, IL-4, IL-6 and TNF-a had decreased significantly in group 2 (p < 0.005 for IL-4 and p < 0.05 for the others); whereas in group 1, IL-2 and IFN-g showed a significant increase (p < 0.005) compared with the end of anaesthesia and surgery level. In conclusion, TIVA with propofol, sufentanil and atracurium does not seem to have a significant effect on IL-1b, IL-4, IL-6, TNF-a and IFN-g release. IL-2 was the only cytokine to show a significant decrease due to the effect of anaesthesia alone in both groups. The cytokine response to open cholecystectomy stimulated both the pro-inflammatory (IL-1b, IL-6 and TNF-a) and the anti-inflammatory (IL-4) components, while this response was absent in laparoscopic cholecystectomy.

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Patterns of cytokines, plasma endotoxin, plasminogen activator inhibitor, and acute-phase proteins during the treatment of severe sepsis in humans

Cited by 179 publications

References 0 publications

Relation between cytokines and routine laboratory data in children with septic shock and purpura

Relation between cytokines and routine laboratory data in children with septic shock and purpura

The immunomodulatory effects of prolonged intravenous infusion of propofol versus midazolam in critically ill surgical patients

The effect of anaesthesia and surgery on plasma cytokine production

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