Fever and malnutrition: endogenous pyrogen/interleukin-1 in malnourished patients

The effect of protein-calorie malnutrition on the release of endogenous pyrogen/interleukin-1 (EP/IL-1), the protein responsible for the induction of fever, was investigated in 18 hospitalized patients with chronic malnutrition. Monocytes from the 18 patients and from 19 healthy controls were cultured overnight after stimulation with Staphylococcus epidermidis. The presence of EP/IL-1 was tested by injecting culture supernatants into rabbits and measuring the maximum febrile response (delta Tmax). Malnourished patients produced significantly less EP/IL-1 than controls (delta Tmax = 0.27 +/- 0.04 degrees C for patients vs 0.49 +/- 0.03 degrees C for controls, p less than 0.001). The poor febrile response in the malnourished patients was related to low serum albumin and retinol-binding protein, but not to thyroxine-binding albumin or lymphocyte number. This abnormality may help explain the poor febrile response often noted in hospitalized debilitated patients.