PROGNOSTIC VALUES OF SERUM CYTOKINES IN SEPTIC SHOCK

Objective. To prospectively evaluate the prognostic values of two seru m cytokine levels, TNFalpha and IL6 serially measured at predetermined intervals in septic shock patients unresponsive to correction of hypo xaemia and plasma volume expansion and treated according to a strict p rotocol designed to meet specific therapeutic goals (goal-directed the rapy). The evolution of serum lactate levels and oxygen-derived parame ters was also investigated. Design: A prospective case series study. P atients were followed-up until they were discharged from the hospital, or died. Setting. ICU of a university hospital. Patients: 30 consecut ive patients with septic shock of various origins. Interventions: The therapy was aimed at achieving and maintaining for at least 24 h supra normal values CI (greater-than-or-equal-to 4.01 . min-1 . m-2), oxygen delivery (DO2 greater-than-or-equal-to 550 ml . min-1 . m-2) and oxyg en uptake (VO2 greater-than-or-equal-to 150 ml . min-1 . m-2) using a combination of fluid loading, norepinephrine, dobutamine and dopamine. A significant decrease in TNFalpha levels was associated with a favou rable outcome while TNFalpha levels remained elevated in the patients who died in shock or of multiple organ failure. No prognostic value wa s associated with changes in IL6 concentrations. In a stepwise logisti c regression analysis, only TNFalpha levels contributed significantly to prediction of patients' outcome. A significant decrease in serum la ctate concentrations was observed both in survivors and in patients wh o survived the episode of septic shock, but subsequently died of multi ple organ failure. A positive DO2/VO2 relationship was observed only i n survivors but did not contribute significantly to prediction of pati ent outcome. Conclusions: TNFalpha is a major mediator involved in the pathogenesis of septic shock and its decrease was significantly assoc iated with a favourable outcome. IL6 is certainly involved in the path ophysiology of septic shock but further studies are required to determ ine whether or not it is directly involved in the mediation of late an d lethal complications of septic shock. Serum lactate levels and oxyge n-derived variables were of less interest as prognostic factors.