PLASMA-LEVELS OF CYTOKINES IN PRIMARY SEPTIC SHOCK IN HUMANS - CORRELATION WITH DISEASE SEVERITY

Thirteen patients (median age, 20 years) with life-threatening primary septic shock (10 meningococcal, 3 pneumococcal infections) were studi ed prospectively. All had a short history of sepsis (less than or equa l to 24 h) and no severe underlying disease. Two (15%) died. The logar ithm of the initial plasma levels of tumor necrosis factor (TNF)-alpha , interleukin (IL)-1 beta, IL-6, IL-1 receptor antagonist (ra), and pl asminogen activator inhibitor (PAI)-1 correlated significantly with AP ACHE II scores (r(2) = .67, .57, .68, .81, and .68, respectively). The plasma levels of endotoxin, TNF-alpha, IL-1 beta, and PAI-1 decreased toward normal levels within the first 24 h of treatment, but IL-6 and IL-1ra levels remained high until clinical recovery. On admission, th e molar excess of IL-1ra to IL-1 beta was >2000-fold in 11 of the 13 p atients. Acute plasmapheresis in 11 of the 13 patients significantly i ncreased the plasma clearance of TNF-alpha (P = .02).