An Unbalanced Inflammatory Cytokine Response Is Not Associated With Mortality Following Sepsis: A Prospective Cohort...

Area of Science:

• Critical Care Medicine
• Immunology
• Sepsis Pathophysiology

Background:

• Sepsis mortality is theorized to result from either excessive inflammation or immune suppression.
• Understanding the balance of pro- and anti-inflammatory mediators is crucial for predicting sepsis outcomes.

Purpose of the Study:

• To assess the association between inflammatory (im)balance, measured by interleukin-6 and interleukin-10 levels, and mortality in sepsis patients.
• To investigate the relationship between inflammatory markers and the development of ICU-acquired infections.

Main Methods:

• Prospective observational cohort study in two tertiary ICUs in The Netherlands.
• Measured plasma interleukin-6 and interleukin-10 concentrations at ICU admission, day 4, and ICU discharge in 708 severe sepsis or septic shock patients.
• Analyzed the association between inflammatory markers and 4-day, 28-day, and 1-year mortality using Poisson regression.

Main Results:

• Both interleukin-6 and interleukin-10 levels were independently associated with mortality.
• The interaction term between interleukin-6 and interleukin-10 (inflammatory balance) was not significantly associated with early, intermediate, or late mortality.
• Inflammatory imbalance on day 4 was associated with an increased risk of developing ICU-acquired infections.

Conclusions:

• While individual pro-inflammatory and anti-inflammatory cytokine levels correlate with sepsis mortality, their balance does not appear to be a significant predictor of death.
• Inflammatory imbalance on day 4 of ICU stay may be a risk factor for secondary infections in sepsis patients.