Serum cytokine differences in severely burned children with and without sepsis
Serum cytokine differences in severely burned children with and without sepsis
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DOI：
10.1097/01.shk.0000235138.20775.36
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发表时间：
2007-01-01
期刊：
影响因子：
3.1
通讯作者：
Jeschke, Marc G.
中科院分区：
文献类型：
--
作者：
Finnerty, Celeste C.;Herndon, David N.;Jeschke, Marc G.
其目的是确定烧伤后早期的血清细胞因子谱是否可以用来识别有高风险发展和随后死于脓毒症的患者。设计了一项病例系列研究，以确定血清细胞因子图谱是否可以识别在入院时发展和死亡脓毒症风险最高的患者。所有患者都按照我们机构的烧伤护理标准进行治疗。研究对象为44例烧伤后7d内入院的1~19岁儿童，占体表面积的40%以上。入院时无一例感染或败血症。在第一次手术前采集血清，测定17种细胞因子的浓度。脓毒症的诊断是在尸检中进行病原体鉴定的。15例患者发生脓毒症并死亡，29例患者未发生败血症并存活。烧伤后继发脓毒症患者入院时血清IL-6、IL-8、IL-10、粒细胞-单核细胞集落刺激因子、干扰素-γ、肿瘤坏死因子和IL-12p70水平较烧伤后未发生脓毒症患者显著升高(P<0.05)。多因素Logistic回归分析显示，IL-6、IL-12p70升高和肿瘤坏死因子降低的患者死于脓毒症的风险增加。血清IL-6、IL-8、IL-10、粒细胞-单核细胞集落刺激因子、干扰素-γ、肿瘤坏死因子和IL-12 p70在脓毒症死亡组和未死于败血症组的表达不同。此外，血清IL-6、IL-12p70和肿瘤坏死因子可用于判断烧伤后脓毒症死亡的高危人群。
The aim was to determine whether serum cytokine profiling early after burn can be used to identify patients at high risk of developing and subsequently dying of sepsis. A case series study was designed to determine whether serum cytokine profiling allows identification of patients at highest risk of developing and dying of sepsis at the time of hospital admission. All patients were treated according to the standard of burn care at our facility. Forty-four children (1-19 years old) with more than 40% of total body surface area and admitted within 7 days postburn were studied. None had infections or sepsis at the time of admission. Serum was collected before the first operation, and concentrations of 17 cytokines were measured. Diagnosis of sepsis was made at autopsy with identification of the pathogen. Fifteen patients developed sepsis and died, whereas 29 patients did not develop sepsis and survived. Significant elevations in serum interleukin (IL) 6, IL-8, IL-10, granulocyte-monocyte colony-stimulating factor, interferon gamma (IFN-gamma), tumor necrosis factor (TNF), and IL-12 p70 were found at the time of admission of patients who subsequently developed and died of sepsis when compared with burned patients who did not develop sepsis (P < 0.05). Multiple logistic regression analysis revealed that patients with a combination of elevated IL-6 and IL-12 p70 and lower TNF had an elevated risk of dying of sepsis. Serum IL-6, IL-8, IL-10, granulocyte-monocyte colony-stimulating factor, IFN-gamma, TNF, and IL-12 p70 are expressed differently in patients who die of sepsis versus those who never become septic. In addition, serum IL-6, IL-12 p70, and TNF can be used to identify burned patients who are at high risk of death from sepsis.