Critical Care and Shock

Pro- and Anti-Infl ammatory Balance of Septic Patients is Associated with Severity and Outcome

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Purpose: To study inflammatory profile in patients with sepsis, severe sepsis and septic shock with regards to organ dysfunction and outcome, and to identify a pattern associated with more catastrophic course of illness, organ failure and risk of death.

Material and methods: Twenty-nine consecutive patients with sepsis admitted to a medical Intensive Care Unit of a tertiary university hospital (November 2002-December 2003). Plasmatic levels of interleukin-6 (IL-6) and interleukin-10 (IL- 10) as pro-inflammatory and anti-inflammatory markers were measured at baseline, 12, 24 and 48 hours of evolution.

Results: There is a positive association between higher levels of IL-6 and severity of the septic process, organ dysfunctions and risk of death, statistically significant at anytime (at baseline, 12, 24 and 48 hours, p <0.05). Higher IL-6/IL-10 ratios associate significantly with risk of death at 24 hours (RR=1.45 if higher or equal to the median).

Conclusions: Plasmatic biomarkers measurement during the initial phase of sepsis may help to individualize therapy. An evaluation at 24 h based on IL-6/IL-10 ratio may anticipate a more aggressive inflammatory profile. These patients would specially benefit from immunomodulating therapies to improve survival.