INFLAMMATORY CYTOKINE AND NITRIC-OXIDE RESPONSES IN PEDIATRIC SEPSIS AND ORGAN FAILURE

Objective: To examine the relationship of circulating proinflammatory and anti inflammatory cytokine concentrations to nitric oxide and orga n failure in pediatric sepsis, Design: Prospective study, Setting: Ped iatric intensive care unit (ICU), Children's Hospital of Pittsburgh, U niversity of Pittsburgh. Patients: Nineteen patients with a diagnosis of sepsis admitted to the pediatric ICU, Twelve uninfected critically ill patients served as controls, Interventions: None, Measurements and Main Results: Plasma interleukin (IL)-10, IL-6, and nitrite/nitrate c oncentrations were measured and compared with an index of organ failur e daily for 3 days after presentation with the sepsis syndrome, Childr en with increased plasma IL-6 concentrations (n = 6) had increased pla sma nitrite/nitrate concentrations (p < .01 on each day), increased or gan failure scores (p < .05 on days 2 and 3), and the highest plasma I L-10 concentrations (p < .05 on days 1 and 3, p = .054 on day 2) when compared with children with sepsis and undetectable IL-6 concentration s. Children with sepsis and detectable IL-6 concentrations, and childr en with undetectable IL-6 concentrations, both had increased nitrite/n itrate concentrations (p < .005 on days 1 through 3) and increased IL- 10 concentrations (p > .05 on days 1 and 2) compared with controls, Ch ildren with in creased IL 6 concentrations had higher organ failure on each day (p < .01), and children with undetectable IL-6 concentration s had higher organ failure on days 1 and 2 only (p < .005) when compar ed with controls, Organ failure improved over time in the children wit h undetectable IL-6 concentrations (p < .005). Conclusions: Increased plasma nitrite/nitrates and increased organ failure scores occurred in the children with sepsis who had an exaggerated proinflammatory state , despite a pronounced antiinflammatory response, When the anti-inflam matory response predominated, and the proinflammatory state was dampen ed, organ failure status improved.