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Is TNF-alpha a prognostic factor in patients with sepsis?
Reiner Schaumann1, Tilman Schlick, Martin Schaper
1Medizinische Klinik III/Infektiologie, Klinikum der Johann Wolfgang Goethe-Universität, Frankfurt, Germany.
Summary
Tumor necrosis factor-alpha (TNF-alpha) levels were higher in patients with Gram-negative infections and those who did not survive. However, underlying disease, not the infecting organism, more significantly impacts TNF-alpha levels.
Area of Science:
- Internal Medicine
- Infectious Diseases
- Immunology
Background:
- Hospitalized patients with acute infections often exhibit elevated inflammatory markers.
- Tumor necrosis factor-alpha (TNF-alpha) is a key cytokine implicated in inflammatory responses during infection.
Purpose of the Study:
- To prospectively investigate TNF-alpha levels in hospitalized patients with acute infections.
- To correlate TNF-alpha levels with infection type, patient status (immunocompromised), and clinical outcomes.
Main Methods:
- Prospective study of 58 hospitalized patients (63 infection episodes) over 7 months.
- Inclusion criteria: clinical signs of acute infection, fever, tachycardia, tachypnea.
- TNF-alpha levels measured by enzyme immunoassay from day 1 to 13 post-diagnosis.
Main Results:
- Microbiological documentation in 46% of episodes.
- Significantly higher median TNF-alpha levels in Gram-negative vs. Gram-positive infections (p=0.002).
- Non-survivors showed significantly higher median TNF-alpha levels than survivors (p=0.0001).
Conclusions:
- TNF-alpha levels are elevated in severe infections and associated with mortality.
- Inter- and intrapatient variability in TNF-alpha levels complicates direct outcome correlation.
- Underlying disease appears to have a greater influence on TNF-alpha kinetics than the specific infecting organism.