Cytokine profile in critically ill and/or injured patients with secondary sepsis - influence of different pathogens

Abstract

Background/Aim. The role of the complex sepsis-related immune response has not been fully clarified, and still remains a subject matter of investigations. Nowadays, sepsis is considered a dynamic syndrome characterised by many, often antagonistic, phenomena from hyperinflammation to anergy, or immunoparalysis. On the basis of pro- and anti-inflammatory mediators in the critically ill with sepsis, the aim of the study was to determine whether the cytokine profile differs according to the type of bacterial causative agent, as well as to assess the prognostic value regarding the outcome. The outcome measure has been hospital mortality. Methods. Blood serum samples have been taken from 125 critically ill patients with severe secondary sepsis as a consequence of peritonitis, pancreatitis, or trauma, who had been admitted to the surgical intensive care unit (SICU). The average age of the patients was 57.7?17.3. Of the total number of patients, 84 (67,2%) were males, and 41 (32,8%) were females. The levels of pro-inflammatory ? interleukin 1-alpha (IL-1?), IL-1?, IL-6, IL-8, IL-12?70, IL-17?, tumor necrosis factor alpha (TNF?), interferon-gamma (IFN-?), interferon-gamma-inducible protein-10 (IP 10), monocyte chemoattractant protein-1(MCP-1), macrophage inflammatory protein alpha and beta (MIP-1? and MIP-1?), as well as anti-inflammatory mediators IL-4, IL-10, IL-13, IL-27, IL-31 and IL-33 were determined at three time intervals - on the day of admission (the first day), and then on the third and fifth day. Through standard microbiological analyses, the type of the bacterial causative agent has been determined. Results. On the third day of measurement, significant differences in the cytokine levels with regard to the nature of bacteremia were determined in all pro- and anti-inflammatory cytokines, except for IL-8. Generally, the lowest levels were observed in patients with polymicrobial blood culture. On the first and fifth days of measurement, no significant differences in the cytokine levels with regard to the nature of bacteriemia was found. The only significant predictor of the lethal outcome on the first measurement day was IL-17?, AUR ROC of 0,665 (95% confidence interval of 0,519-0,791, ?=0.034) with secondary sepsis as a complication of peritonitis. Conclusion. According to the type of the bacterial causative agent, the lowest levels of cytokines have been observed in patients with the polymicrobial blood culture. IL- 17? is a good predictor of the outcome in patients with peritonitis as an underlying condition of secondary sepsis. The low level of IL-17? in these patients predicted a lethal outcome on the first day of measurement. On the other hand, the levels of other cytokines correlated with the outcome only on the fifth day of measurement, and they were higher in survivors than in non-survivors.