PURPOSE: To investigate whether baseline protein expression levels of pro-inflammatory cytokines, anti-inflammatory cytokines, or their ratios influence the development of subsequent HAI (health care associated infections) in patients with sepsis.
METHODS: Prospective observational study of 78 Veterans admitted to MICU with sepsis. Baseline plasma levels of IL-6 and IL-10 were measured using multiplex bead based assay. Subjects were monitored daily through ICU discharge for development of HAI using CDC guidelines. Exaggerated inflammation was defined as the 4th quartile (IL-6 and IL-10) compared to other quartiles.
RESULTS: Seventeen (21.7%) subjects developed at least one HAI during their ICU stay. There were no significant differences in baseline levels of pro-inflammatory cytokine, anti-inflammatory cytokine, or their ratio among subjects who did and did not develop HAI. A higher percentage of subjects with an exaggerated inflammatory response developed HAI (IL-6: 31.6% vs. 18.6%; IL-10: 26.3% vs. 20.3%), although not significant. Subjects with exaggerated IL-6 levels had a higher sequential organ failure assessment score (7.5 ± 6.4 vs. 3.7 ± 3.6, p = 0.02), vasopressor use (73.7% vs. 23.7%, p < 0.0001), steroid use (73.7% vs. 44.1%, p = 0.03), and arrythmias (52.6% vs. 18.6%, p = 0.007) compared to those with a lower inflammatory response. Steroid use was the only significant difference among participants with exaggerated IL-10 versus those lower levels (84.2% vs. 40.7%, p = 0.001). ICU Survival was similar for all participants regardless of baseline pro- or anti-inflammatory cytokine level.
CONCLUSIONS: Exaggerated systemic inflammation may be associated with increased organ failure and serious health effects. However, this study may have been underpowered to detect HAI and early steroids use may have influenced baseline cytokine levels.
CLINICAL IMPLICATIONS: Monitoring cytokine levels may provide early detection of those at risk for HAI.
DISCLOSURE: The following authors have nothing to disclose: Reba Umberger, Carol Thompson, Ann Cashion, David Kuhl, Jim Wan, Charles Yates, Muthiah Muthiah, Gianfranco Meduri
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