Comparison of inflammatory cytokine concentration and physiologic parameters in septic shock

Cytokine-related systemic intravascular inflammation may represent a common pathogenic link between initial insult and multiple organ failure in septic shock patients. We conducted a prospective study with controls in the National Taiwan University Hospital intensive care unit to compare plasma levels of tumor necrosis factor alpha (TNF-alpha), interleukin 6 (IL-6), and circulating intercellular adhesion molecule 1 (cICAM-1) with clinical physiologic parameters in the outcome of patients with septic shock. Healthy volunteers (n = 37) and patients with septic shock admitted to the unit from January to December 1994 (n = 31) were enrolled. Clinical data, APACHE (Acute Physiology and Chronic Health Evaluation) III scores, multiple organ failure scores, the presence of acute respiratory distress syndrome, and outcome were evaluated. The plasma levels of TNF-alpha, IL-6, and cICAM-1 were measured using enzyme-linked immunosorbent assay. Subgroups of survivors and nonsurvivors were compared for plasma levels of these factors or days 1, 2, 3, 7, and 14 after diagnosis of septic shock. Of the patients with septic shock, 20 survived and 11 died. The initial plasma levels of IL-6 were significantly higher in nonsurvivors (p < 0.05). There was a significant inverse correlation between plasma IL-6 level and survival in the first week (r = 0.4297-0.7242, p < 0.05). APACHE III score (r = 0.4335, p = 0.015), acute respiratory distress syndrome (r = 0.5913, p < 0.001), and multiple organ failure score (r = 0.736, p < 0.001) were more strongly (negatively) correlated with survival than the concentrations of TNF-alpha and cICAM-1 by Spearman's rank sum test. Our results showed that in patients with septic shock, of the inflammatory cytokines, only IL-6 showed significantly higher plasma levels in the nonsurvivor group. Inflammatory cytokine levels were not more strongly correlated with the outcome of patients with septic shock than physiologic parameters.