Servicio de Neumología, Hospital Universitario La Fe, Valencia, Spain.
Eur Respir J. 2011 Feb;37(2):393-9. doi: 10.1183/09031936.00040710. Epub 2010 Jul 1.
Raised systemic levels of interleukin (IL)-6 and IL-10 cytokines have been associated with poorer outcome in community-acquired pneumonia. The aim of our study was to identify potential associated factors with increased levels of IL-6, IL-10, or both cytokines. We performed a prospective study of 685 patients admitted to hospital with community-acquired pneumonia. IL-6 and IL-10 were measured in blood in the first 24 h. 30-day mortality increased from 4.8% to 11.4% (p = 0.003) when both cytokines were higher than the median. Independent associated factors with an excess of IL-6 were neurologic disease, confusion, serum sodium < 130 mEq·L⁻¹, pleural effusion, and bacteraemia. The associated factors for an excess of IL-10 were respiratory rate ≥ 30 breaths·min⁻¹, systolic blood pressure < 90 mmHg and glycaemia ≥ 250 mg·dL⁻¹. The independent associated factors for an excess of both cytokines were confusion, systolic blood pressure < 90 mmHg, pleural effusion and bacteraemia. Protective factors were prior antibiotic treatment and pneumococcal vaccination. Different independent factors are related to an excess of IL-6 and IL-10. Confusion, hypotension, pleural effusion and bacteraemia were associated with the inflammatory profile with the highest mortality rate, whereas anti-pneumococcal vaccination and previous antibiotic treatment appeared to be protective factors.
循环系统中白细胞介素（IL）-6 和 IL-10 细胞因子水平升高与社区获得性肺炎不良预后相关。本研究旨在确定与升高的 IL-6、IL-10 或两种细胞因子相关的潜在因素。我们对 685 名因社区获得性肺炎住院的患者进行了前瞻性研究。在入院的前 24 小时内测量血液中的 IL-6 和 IL-10。当两种细胞因子均高于中位数时，30 天死亡率从 4.8%上升至 11.4%（p=0.003）。与 IL-6 过量相关的独立相关因素包括神经系统疾病、意识障碍、血清钠<130 mEq·L⁻¹、胸腔积液和菌血症。与 IL-10 过量相关的相关因素为呼吸频率≥30 次·min⁻¹、收缩压<90 mmHg 和血糖≥250 mg·dL⁻¹。与同时存在两种细胞因子过量相关的独立相关因素为意识障碍、收缩压<90 mmHg、胸腔积液和菌血症。保护性因素是先前使用抗生素治疗和接种肺炎球菌疫苗。不同的独立因素与 IL-6 和 IL-10 的过量有关。意识障碍、低血压、胸腔积液和菌血症与炎症特征相关，死亡率最高，而接种肺炎球菌疫苗和先前使用抗生素治疗似乎是保护性因素。
