T. Staudinger et al., INFLUENCE OF PENTOXIFYLLINE ON CYTOKINE LEVELS AND INFLAMMATORY PARAMETERS IN SEPTIC SHOCK, Intensive care medicine, 22(9), 1996, pp. 888-893
Objective: To evaluate the influence of pentoxifylline (PTX), a phosph
odiesterase inhibitor, on cytokines and inflammatory proteins in patie
nts suffering from septic shock. Design: Prospective study comparing a
therapy group to a matched control group. Setting. Medical intensive
care unit at a university hospital. Patients: Twenty four patients ful
filling the criteria of septic shock were included in this study. Twel
ve patients received PTS (therapy group) and 12 patients matched for d
iagnosis, age and gender served as the control group. Interventions: P
entoxifylline at 1 mg/kg per hour over 24 h in the therapy group. Meas
urements and results: Cytokine levels [tumor necrosis factor-alpha (TN
F)], soluble TNF receptor [TNF-R], and interleukin-6 [IL-6] and inflam
matory proteins [C-reactive protein, alpha-1-antitrypsin (AAT), fibron
ectin, and haptoglobin], as well as hemodynamic parameters and the APA
CHE III score were evaluated before initiation of therapy and 24 h lat
er. After 24 h, TNF levels were significantly lower in the therapy gro
up (p = 0.013), while IL-6 levels were significantly higher in the the
rapy group (p = 0.030). Within the 24 h TNF declined significantly in
the therapy group (p = 0.006), while IL-6 showed a significant increas
e (p = 0.043). AAT and the APACHE III score tended to differ significa
ntly after 24 h between the groups [AAT levels higher in the therapy g
roup (p = 0.05), APACHE III score lon er (p = 0.05)]. In the therapy g
roup, the systemic vascular resistance index was significantly higher
after 24 h (p = 0.0026) whereas the cardiac index declined (p = 0.035)
. Conclusions: PTX does influence TNF levels in septic shock patients.
Nevertheless, inhibiting a single mediator in severe septic shock can
not stop the inflammatory overreaction.