INCREASED PLASMA-CONCENTRATIONS OF SOLUBLE TUMOR-NECROSIS-FACTOR RECEPTORS IN SEPSIS SYNDROME - CORRELATION WITH PLASMA CREATININE VALUES

Objectives: Tumor necrosis factor (TNF) is an important mediator in th e complex pathophysi ology of sepsis syndrome. Although a positive cor relation with mortality rate has been demonstrated, TNF has not been f ound consistently in sepsis. Since prolonged increases in soluble TNF receptor concentrations were demomstrated after endotoxin and TNF admi nistration, we investigated whether the measurement of TNF receptor co ncentrations could provide a better indicator of disease than plasma T NF and interleukin (IL)-6 concentrations. Design: Prospective analysis . Setting: General intensive care unit (ICU) of a university hospital. Patients: Twenty-six patients with sepsis syndrome and proven bactere mia. Measurements and Main Results: Plasma peak concentrations of the soluble 55-kilodalton molecular weight TNF receptor were significantly higher (p < .005) in nonsurvivors compared with survivors of sepsis s yndrome, whereas the difference in peak concentrations of the soluble 75-kilodalton TNF receptor did not reach significance (p = .06). In co ntrast to TMF peak concentrations (p = .14), significantly higher (p < .05) IL-6 peak concentrations were measured in nonsurvivors. Besides the positive correlation between the soluble 55-kilodalton TNF recepto r and the soluble 75-kilodalton TNF receptor (r(2) = .68; p < .0001), peak concentrations of both soluble 55-kilodalton TNF receptor and 75- kilodalton TNF receptor correlated significantly with plasma creatinin e values, an indicator of renal function (r(2) = .60; P < .0001 and r( 2) = .44; p < .001, respectively). Plasma creatinine concentrations we re significantly higher in nonsurvivors (p < .001). Conclusions: In th e population studied, plasma-soluble TNF receptor concentrations corre lated with outcome as well as with plasma creatinine concentrations. T he data presented suggest that increased plasma-soluble TNF receptor c oncentrations in patients with sepsis syndrome are merely the result o f renal failure complicating sepsis, and are similarly correlated with mortality rate.