Elevated Serum Interleukin-10 at Time of Hospital Admission Is Predictive of Mortality in Patients With Staphylococcus aureus Bacteremia
Elevated Serum Interleukin-10 at Time of Hospital Admission Is Predictive of Mortality in Patients With Staphylococcus aureus Bacteremia
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DOI：
10.1093/infdis/jis552
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发表时间：
2012-11-15
影响因子：
6.4
通讯作者：
Sakoulas, George
中科院分区：
文献类型：
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作者：
Rose, Warren E.;Eickhoff, Jens C.;Sakoulas, George
背景。金黄色葡萄球菌菌血症（SaB）具有相当高的发病率和死亡率。我们检查了白细胞介素 (IL)-10、促炎细胞因子和终末补体的血清浓度对患者生存和 SaB 持续时间的预测价值。方法。前瞻性收集三级医疗中心连续 SaB 患者的临床信息。使用酶联免疫测定法对临床表现当天获得的患者血清样本进行肿瘤坏死因子-α、IL-1β、IL-10 和补体膜攻击复合物 C5b-9 浓度的测定。逻辑回归确定了死亡率和菌血症持续时间的预测因素。结果。在 59 名 SaB 患者中，14% 死亡，17% 出现长期菌血症（>4 天）。 IL-10 血清浓度升高 (>7.8 pg/mL) 导致所有 8 名患者死亡，而 IL-10 正常的患者没有死亡 (P = .016)。缺乏 IL-1 β 反应（4 天。在多变量分析中，患者年龄（比值比 [OR]，1.16；P = .022）、菌血症持续时间（OR，1.16；P = .031）和血清 IL-10（OR，1.05；P = .014）被确定为患者死亡率的独立预测因素。结论。SaB 死亡率严格限于高浓度患者IL-10 浓度。我们建议 SaB 的未来临床试验根据 IL-10 和 IL-1 β 血清浓度对患者进行分层，以便更好地评估治疗干预对患者结果的影响。
Background. Staphylococcus aureus bacteremia (SaB) carries considerable morbidity and mortality. We examined the predictive value of serum concentrations of interleukin (IL)-10, proinflammatory cytokines, and terminal complement on patient survival and SaB duration.Methods. Clinical information on consecutive patients with SaB at a tertiary medical center were collected prospectively. Patient serum samples obtained at the day of clinical presentation were assayed for tumor necrosis factor-alpha, IL-1 beta, IL-10, and complement membrane attack complex C5b-9 concentrations using enzyme-linked immunoassay. Logistic regression identified predictors of mortality and duration of bacteremia.Results. In 59 patients with SaB, 14% died and 17% had prolonged bacteremia (>4 days). Elevated IL-10 serum concentrations (>7.8 pg/mL) identified all 8 patients who died, whereas there were no deaths in patients with normal IL-10 (P = .016). The lack of an IL-1 beta response (4 days. In multivariate analysis, patient age (odds ratio [OR], 1.16; P = .022), duration of bacteremia (OR, 1.16; P = .031), and serum IL-10 (OR, 1.05; P = .014) were identified as independent predictors of patient mortality.Conclusions. SaB mortality was confined strictly to patients with elevated IL-10 concentrations. We recommend that future clinical trials of SaB stratify patients according to IL-10 and IL-1 beta serum concentrations in order to better evaluate the impact of therapeutic interventions on patient outcome.