ELEVATED INTERLEUKIN-1 RECEPTOR ANTAGONIST LEVELS IN PEDIATRIC SEPSISSYNDROME

Objective: To measure plasma levels of interleukin-1 beta, interleukin -1 receptor antagonist (IL-1ra), and tumor necrosis factor alpha in ch ildren with sepsis syndrome. Study design: A prospective, observationa l study of 14 patients aged 5 months to 13 years with sepsis syndrome admitted to a pediatric intensive care unit. Cytokine levels were meas ured by enzyme-linked immunosorbent assay at baseline and at 12, 24, a nd 48 hours and compared with the levels of 21 age-matched control sub jects. Results: The mean pediatric risk of mortality score was 16.1. B acterial and viral sepsis was confirmed in five and three patients, re spectively. Compared with the levels in the control subjects (mean lev el of IL-1ra: 654 pg/ml), the IL-1ra levels were elevated in the septi c patients, with mean values of 17855 (p < 0.001), 12771 (p < 0.001), 9182 (p < 0.01), and 2296 pg/ml (p = not significant) at baseline and at 12, 24, and 48 hours, respectively. The IL-1ra level was greater th an 1000-fold higher than the IL1 beta level at all time points in 13 o f 14 septic patients. Conclusions: At the time of hospital admission, circulating IL-1ra levels in a cohort of children with sepsis syndrome were at concentrations known to block IL-1 receptors. Thus additional benefit from exogenous IL-1ra therapy would be questionable. Further studies are indicated to determine whether there is a population of pa tients with sepsis who could benefit from administration of exogenous IL-1ra.