MONOCYTE TUMOR-NECROSIS-FACTOR RECEPTOR LEVELS AS A PREDICTOR OF RISKIN HUMAN SEPSIS

Objective: To assess peripheral blood monocyte tumor necrosis factor r eceptor (TNFR) levels and plasma soluble tumor necrosis factor recepto r (sTNFR) concentrations in critically ill patients with sepsis syndro me. Design: Prospective, descriptive cohort study with no intervention s. Setting: Surgical intensive care unit of a tertiary-care hospital a ssociated with a university medical school. Patients: Twenty-one patie nts with a documented source of infection who met currently accepted c riteria for sepsis syndrome/septic shock. Main Outcome Measures: Plasm a sTNFR p55 and p75 values were quantified by enzyme-linked immunosorb ent assay, and monocyte TNFR levels were assessed by fluorescence flow cytometry after the monocytes were stained with biotinylated human re combinant TNF-alpha and streptavidin-phycoerythrin. Results: Compared with healthy controls, plasma sTNFR p55 and p75 values were significan tly higher (P<.01) in both surviving and nonsurviving patients with se psis; in nonsurviving patients with sepsis, however, only sTNFR p55 va lues were significantly (P<.05) higher than in surviving patients with sepsis. By contrast, monocytes from the nonsurviving patients with se psis manifested a significant (P<.01) and sustained (up to 4 days) dec rease in cell surface TNFR values compared with either the normal cont rols or the surviving patients with sepsis. Conclusions: Assessment of monocyte surface TNFR values may provide a rapid prognostic indicator for patients with sepsis who are at increased risk of death.