Division of Pulmonary Disease and Critical Care Medicine, Department of Internal Medicine, Virginia Commonwealth University, 1200 East Broad Street, Richmond, VA 23298-0050, USA.
Crit Care. 2010;14(6):R230. doi: 10.1186/cc9385. Epub 2010 Dec 22.
Patients with alcohol use disorders (AUD) are at increased risk of developing sepsis and have higher mortality. AUD are associated with higher cortisol and anti-inflammatory cytokine profile. Higher cortisol increases risk of death in septic patients. The relationship between AUD and cortisol in septic patients is unknown. We aimed to study this relationship and postulated that AUD would be associated with higher cortisol and anti-inflammatory cytokine profile.
This was a prospective cohort study of 40 medical intensive care unit (ICU) patients admitted with sepsis. Cortisol, anti-inflammatory interleukin (IL) 10, and pro-inflammatory IL1β, IL6, tumor necrosis factor (TNF) α were measured.
Thirteen (32%) out of 40 patients had AUD. AUD patients had higher cortisol by univariate (39 microg/dl versus 24, P = 0.04) and multivariable analyses (44 microg/dl versus 23, P = 0.004). By univariate analyses, AUD patients had higher IL10 (198 picog/dl versus 47, P = 0.02) and IL6 (527 picog/ml versus 156, P = 0.048), but similar IL1β and TNFα. By multivariable analyses, AUD patients had higher IL10 (182 picog/dl versus 23, P = 0.049) but similar IL1β, IL6, and TNFα. AUD patients had lower IL1β/IL10 (univariate 0.01 versus 0.10, P = 0.04; multivariable 0.01 versus 0.03, P = 0.04), lower TNFα/IL10 (univariate 0.15 versus 0.52, P = 0.03; multivariable 0.11 versus 0.63, P = 0.01), but similar IL6/IL10.
AUD are common diagnoses among medical ICU patients with sepsis. Patients with AUD have higher cortisol concentrations and have differences in cytokine expression. Future studies should seek to determine if these differences may explain the higher severity of illness seen in patients with sepsis and AUD.
ClinicalTrials.gov: NCT00615862.
患有酒精使用障碍（AUD）的患者发生脓毒症的风险增加，死亡率更高。AUD 与更高的皮质醇和抗炎细胞因子谱有关。较高的皮质醇会增加脓毒症患者的死亡风险。AUD 与脓毒症患者皮质醇之间的关系尚不清楚。我们旨在研究这种关系，并假设 AUD 与更高的皮质醇和抗炎细胞因子谱有关。
这是一项对 40 名因败血症入住重症监护病房（ICU）的患者进行的前瞻性队列研究。测量皮质醇、抗炎性白细胞介素（IL）10 和促炎性 IL1β、IL6、肿瘤坏死因子（TNF）α。
40 名患者中有 13 名（32%）患有 AUD。AUD 患者的皮质醇水平通过单变量（39 mcg/dl 与 24，P = 0.04）和多变量分析（44 mcg/dl 与 23，P = 0.004）更高。通过单变量分析，AUD 患者的 IL10 更高（198 pg/dl 与 47，P = 0.02）和 IL6（527 pg/ml 与 156，P = 0.048），但 IL1β 和 TNFα 相似。通过多变量分析，AUD 患者的 IL10 更高（182 pg/dl 与 23，P = 0.049），但 IL1β、IL6 和 TNFα 相似。AUD 患者的 IL1β/IL10 更低（单变量 0.01 与 0.10，P = 0.04；多变量 0.01 与 0.03，P = 0.04），TNFα/IL10 更低（单变量 0.15 与 0.52，P = 0.03；多变量 0.11 与 0.63，P = 0.01），但 IL6/IL10 相似。
AUD 是 ICU 中患有败血症的患者的常见诊断。患有 AUD 的患者皮质醇浓度较高，细胞因子表达存在差异。未来的研究应旨在确定这些差异是否可以解释患有败血症和 AUD 的患者疾病严重程度更高的原因。
ClinicalTrials.gov：NCT00615862。
