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Admission Cytokine Profiling for ICU Mortality Prediction in Heterogeneous Acute Respiratory Failure: An Exploratory
Joonho Lee1, Jae-Hoon Ko2, Hyunseung Nam3
1Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea.
Diagnostics (Basel, Switzerland)
|June 26, 2026
Summary
Admission cytokine profiles, including CXCL10, IL-18, CCL2, and IL-1Ra, show promise in predicting intensive care unit (ICU) mortality for acute respiratory failure (ARF) patients. These inflammatory biomarkers may enhance early risk stratification beyond traditional clinical factors.
Area of Science:
- Critical Care Medicine
- Immunology
- Respiratory Medicine
Background:
- Acute respiratory failure (ARF) presents diverse causes, making early prognostication difficult.
- Cytokines and chemokines may reflect biological severity and identify high-risk patients.
- This study investigates if cytokine/chemokine profiles offer additional prognostic value in ARF.
Purpose of the Study:
- To evaluate the incremental prognostic value of admission cytokine/chemokine profiles in unselected ARF patients.
- To determine if these biomarkers improve risk stratification beyond established clinical factors.
- To identify candidate inflammatory biomarkers for ICU mortality prediction in ARF.
Main Methods:
- Prospective, single-center cohort study of adult ICU patients with ARF requiring high-intensity respiratory support.
- Plasma samples collected within 24 hours of ARF diagnosis; 19 cytokines/chemokines measured via multiplex immunoassays.
- Logistic regression and ROC curve analysis (AUC) used to assess biomarker associations with ICU mortality.
Main Results:
- 15 of 41 (37%) patients died in the ICU. Non-survivors had higher rates of immunosuppression and hematologic malignancy.
- CXCL10 (IP-10), IL-18, and CCL2 (MCP-1) were elevated in non-survivors; IL-1Ra showed a numerical increase and univariable association with mortality.
- A clinical model (SOFA, immunosuppression, malignancy) had an AUC of 0.74; adding cytokines modestly improved discrimination (AUC 0.76-0.80).
- IL-1Ra, CXCL10, and CCL2 showed significant survival separation in highest-quartile analyses.
Conclusions:
- Admission levels of CXCL10, IL-18, CCL2, and IL-1Ra are associated with ICU mortality in ARF patients.
- These cytokines and chemokines are potential candidate inflammatory biomarkers for early risk stratification.
- Findings require validation in larger, multicenter cohorts to confirm prognostic utility.
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