Tumor Necrosis Factor Levels in Serum and Bronchoalveolar Lavage Fluid of Patients with the Adult Respiratory Distress Syndrome

Abstract

Tumor necrosis factor (TNF) was measured antigenically and functionally in serum and bronchoalveolar lavage fluid (BAL) of patients with ARDS and those at high risk for ARDS. Of 22 patients with ARDS, 14 had sepsis or serious infection as the major clinical predisposition, and 10 of 20 high-risk patients had sepsis or serious infection. Mean levels of TNF in serum of patients with ARDS and high risk showed a trend toward elevation but were not significantly higher than mean serum levels in normal subjects. Mean levels of TNF in BAL of ARDS patients (242 +/- 126 pg/ml) were significantly higher than in normal subjects (9 +/- 5 pg/ml), p less than 0.05. Antigenic levels of TNF were undetectable in approximately half the patients with ARDS or the high-risk state. Levels of TNF in BAL appeared to be highest in the first day of ARDS. There appeared to be no relationship between levels of TNF in serum or BAL and subsequent mortality. However, serum levels of TNF were significantly higher in septic patients than in nonseptic patients, whereas this difference was not apparent in BAL. These results show that functional and antigenic elevations of TNF are present in BAL and perhaps in serum of patients with ARDS or with the high-risk state.

Neutrophil-related cytokines and neutrophil products in bronchoalveolar lavage fluid of a patient with ANCA negative Wegener's granulomatosis

“…However, the serum levels of IL-1β and TNF-α and the BALF level of the latter were below the detection limit in our patient, whilst the BALF level of IL-1β (86 pg·mL -1 ) was higher compared with that of seven healthy volunteers (22.6±4.8 pg·mL -1 ). In this respect, previous reports have demonstrated that, whereas BALF levels of these two cytokines are elevated during the early acute phase of ARDS, the level of TNF-α diminishes more markedly than that of IL-1β in the late phase [18,19]. Thus, it is possible that the presence of TNF-α in the serum at concentrations below the detection limit in our patient was due to the time of serum sampling.…”

Acute lung injury after allogeneic stem cell transplantation: is the lung a target of acute graft-versus-host disease?

“…29,30 Etiology of IPS As shown in Table 5, potential etiologies for IPS are several and include direct toxic effects of SCT conditioning regimens, occult pulmonary infections and the release of inflammatory cytokines that have been implicated in other forms of pulmonary injury. [31][32][33][34][35] Other immunologic factors may also be important as suggested by the association of Table 4 Risk factors for idiopathic pneumonia syndrome GVHD prophylaxis (methotrexate) 3 Acute GVHD (grades II-IV) 2,25 Acute GVHD (grade IV) 3,6 Increasing recipient age (X21 years) 3,25 (440 years) 28 Total body irradiation (TBI) X1200 cGy 2,3,28 ; dose rate of TBI (X6 Cgy/min) 3 Myeloablative conditioning High-dose 1-3 bis chloroethyl-1 nitrosurea 25 Decreased pre-transplant performance status 3 Longer duration from diagnosis to transplant 3 Transplantation for malignancy other than leukemia 6 Transplantation for hematologic malignancy 9 HLA disparity (donor:recipient) 12 IPS and severe GVHD in several large series. 2,3,[5][6][7]11 Moreover acute GVHD often precedes IPS, suggesting a possible causal relationship between the two disorders.…”

Adult respiratory distress syndrome after radical neck dissection

“…24 Cytokines, especially tumour necrosing factor (TNF) were detected in the serum of ARDS patients. 25 Both the coagulation and fibrinolytic system have also been implicated on account of increased procoagulation activity and depressed fibrinolysis, favouring fibrin deposition. 24 In spite of advances made with respect to diagnosis and management, the mortality in ARDS is still very high, and ranges between 40-80%.…”