PLASMA-CONCENTRATIONS OF CYTOKINES, THEIR SOLUBLE RECEPTORS, AND ANTIOXIDANT VITAMINS CAN PREDICT THE DEVELOPMENT OF MULTIPLE ORGAN FAILUREIN PATIENTS AT RISK

Objectives: The aims of this study were: a) to evaluate plasma concent rations of cytokines and their soluble receptors, as well as antioxida nt substances in patients at high risk of developing multiple organ fa ilure; b) to investigate early change; and c) to examine the possible prognostic value of these elements. Design: Prospective analysis. Sett ing: Surgical intensive care unit (ICU) of a university hospital. Pati ents: Sixteen patients at risk for multiple organ failure. Measurement s and Main Results: Ten patients developed multiple organ failure and five of them died. Whereas tumor necrosis factor-alpha (TNF-alpha) pla sma concentrations were only borderline higher in patients developing multiple organ failure, TNF-soluble receptors 55 and 75 were significa ntly increased during all ICU days compared with patients not going in to organ failure. Interleukin-6 plasma concentrations were higher in p atients developing multiple organ failure during the first 2 days afte r ICU admission. The antioxidant vitamin C was significantly decreased in patients going into multiple organ failure during all ICU days. Ot her biochemical markers of antioxidant activity, such as vitamin E, co pper, and zinc plasma concentrations, did not differ between the two g roups. Conclusions: Our data suggest that there is a marked increase i n anti-TNF activity and a decrease of antioxidant defense in patients at risk of developing multiple organ failure. The predictive value of plasma concentrations of circulating TNF-soluble receptors and vitamin C in this type of patient needs further evaluation.