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

Abstract

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.

Interleukin 12 Levels During the Initial Phase of Septic Shock With Purpura in Children: Relation to Severity of Disease

“…35 Serum lactate is related to the degree of circulatory failure. 2 WBC and CRP are negatively correlated with the fulminant evolution of meningococcal septic shock. 36,37 Low serum glucose levels are reported by some authors, 38 although this finding is not well understood.…”

Update on Meningococcal Disease with Emphasis on Pathogenesis and Clinical Management

“…In summary, indicators of FMS and a poor prognosis are the extremes of age; a short period between onset of disease and admission; the absence of meningitis; progressive or widespread skin lesions; shock as shown by a slow capillary refill, cold acra, hypotension, or metabolic acidosis; a moderately elevated or normal C-reactive protein concentration in serum; the absence of leukocytosis; and the presence of thrombocytopenia, DIC, and hypofibrinogenemia. As discussed above (see "Pathophysiology of shock"), high concentrations of cytokines in plasma are also associated with a poor outcome (213). Although the levels of these mediators are a direct reflection of the inflammatory process, long laboratory turnaround times make them unsuitable for prognostic evaluation in daily practice.…”

Immunization with Meningococcal Outer‐Membrane Protein Vesicles Containing Lipooligosaccharide Protects Mice against Lethal Experimental Group BNeisseria meningitidisInfection and Septic Shock

“…Furthermore, passive immunization with antibodies to TNF-a was reported to worsen mortality in murine cecal ligation puncture [12,13] and outcome in patients with less severe sepsis [14,15]. More recently, it has become clear that IL-6 is also involved in the systemic changes that occur during severe meningococcal infections [16,17]. IL-6 was detected in 87.3% of admission serum samples, and the serum level was ∼1000 times higher in patients with septic shock than in patients with meningitis, bacteremia, or combined septic shock and meningitis [3].…”