Simpson A J, Smith M D, Weverling G J, Suputtamongkol Y, Angus B J, Chaowagul W, White N J, van Deventer S J, Prins J M
Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand.
J Infect Dis. 2000 Feb;181(2):621-5. doi: 10.1086/315271.
Raised serum concentrations of tumor necrosis factor (TNF)-alpha, interleukin (IL)-1beta, IL-6, or IL-10 are associated with mortality in patients with sepsis, but it is not known whether elevated cytokine levels are independently predictive of mortality. Cytokine assays (TNF-alpha, IL-6, and IL-10) were performed on admission plasma samples from 172 adult Thai patients with severe melioidosis. Mortality was 31.4%. APACHE II score; septicemia; plasma lactate; TNF-alpha, IL-6, and IL-10 concentrations; and IL-10/TNF-alpha and IL-6/IL-10 ratios were each associated with outcome (P</=.001 for all variables). Only the APACHE II score and either IL-6 or IL-10 concentration were independent predictors of mortality, as determined by use of multiple logistic regression (with cytokine concentrations and ratios entered separately). In a multivariate analysis, including both IL-6 and IL-10, the IL-10 concentration was no longer predictive. Therefore, APACHE II scores and either IL-6 or IL-10 concentration may be the most reliable parameters for stratification of patients in future studies of severe gram-negative sepsis.
血清中肿瘤坏死因子（TNF）-α、白细胞介素（IL）-1β、IL-6或IL-10浓度升高与脓毒症患者的死亡率相关，但细胞因子水平升高是否能独立预测死亡率尚不清楚。对172例成年泰国重症类鼻疽患者入院时的血浆样本进行了细胞因子检测（TNF-α、IL-6和IL-10）。死亡率为31.4%。急性生理与慢性健康状况评分系统（APACHE）II评分、败血症、血浆乳酸、TNF-α、IL-6和IL-10浓度以及IL-10/TNF-α和IL-6/IL-10比值均与预后相关（所有变量P≤0.001）。通过多因素逻辑回归分析（细胞因子浓度和比值分别输入）确定，只有APACHE II评分以及IL-6或IL-10浓度是死亡率的独立预测因素。在包括IL-6和IL-10的多变量分析中，IL-10浓度不再具有预测性。因此，在未来重症革兰氏阴性菌败血症的研究中，APACHE II评分以及IL-6或IL-10浓度可能是对患者进行分层的最可靠参数。
