Plasma concentrations of cytokines, their soluble... : Critical Care Medicine (original) (raw)

Clinical Investigation

Plasma concentrations of cytokines, their soluble receptors, and antioxidant vitamins can predict the development of multiple organ failure in patients at risk

Borrelli, Emma MD; Roux-Lombard, Pascale MD; Grau, Georges E. MD; Girardin, Eric MD; Ricou, Bara MD; Dayer, Jean-Michel MD; Suter, Peter M. MD FCCM

From the Divisions of Surgical Intensive Care (Drs. Borrelli, Grau, Ricou, and Suter), and Immunology and Allergy (Drs. Roux-Lombard and Dayer), Departments of Anesthesiology (Drs. Borrelli, Grau, Ricou, and Suter), Medicine (Drs. Roux-Lombard and Dayer), and Pediatrics (Dr. Girardin), Hopital Cantonal Universitaire, Geneve. Switzerland.

Supported, in part, by grants 3.850-0.86, 31-37786.92, and 32.33902.92 from the Swiss National Research Foundation (FNRS) and by grant 1830 from the Carlos and Elsie De Reuter Foundation.

Address requests for reprints to: Peter M. Suter, MD, Division des Soins Intensifs Chirurgicaux, Hopital Cantonal Universitaire. 1211 Geneve 14, Switzerland.

Abstract

Objectives

The aims of this study were: a) to evaluate plasma concentrations of cytokines and their soluble receptors, as well as antioxidant substances in patients at high risk of developing multiple organ failure; b) to investigate early change; and c) to examine the possible prognostic value of these elements.

Design

Prospective analysis.

Setting

Surgical intensive care unit (ICU) of a university hospital.

Patients

Sixteen patients at risk for multiple organ failure.

Measurements and Main Results

Ten patients developed multiple organ failure and five of them died. Whereas tumor necrosis factor-alpha (TNF-alpha) plasma concentrations were only borderline higher in patients developing multiple organ failure, TNF-soluble receptors 55 and 75 were significantly increased during all ICU days compared with patients not going into organ failure. Interleukin-6 plasma concentrations were higher in patients developing multiple organ failure during the first 2 days after ICU admission. The antioxidant vitamin C was significantly decreased in patients going into multiple organ failure during all ICU days. Other biochemical markers of antioxidant activity, such as vitamin E, copper, and zinc plasma concentrations, did not differ between the two groups.

Conclusions

Our data suggest that there is a marked increase in anti-TNF activity and a decrease of antioxidant defense in patients at risk of developing multiple organ failure. The predictive value of plasma concentrations of circulating TNF-soluble receptors and vitamin C in this type of patient needs further evaluation.

(Crit Care Med 1996; 24:392-397)