PROINFLAMMATORY CYTOKINES, MEASURED IN A MIXED POPULATION ON ARRIVAL IN THE EMERGENCY DEPARTMENT, ARE RELATED TO MORTALITY AND SEVERITY OF DISEASE

Objectives. To investigate whether serum levels of tumour necrosis fac tor alpha (TNF-alpha) and interleukin 6 (IL-6) are related to mortalit y and severity of disease in patients admitted to the Emergency Depart ment (ED). Design. Prospective cohort study. Setting. Emergency Depart ment of a tertiary university hospital. Subjects. A total of 140 patie nts admitted to the ED, representing common acute medical diseases, su ch as stroke, obstructive lung disease, heart failure, myocardial infa rction, angina pectoris, infectious diseases and acute abdominal disor ders. Main outcome measures. APACHE II score at admission, hospital mo rtality and length of stay in hospital (LOS). Results. A moderate rise in cytokine levels (IL-6; 50-300 ng L-1, TNF-alpha; 10-70 ng L-1) was found in all diagnosis-groups, with the most pronounced elevation see n in patients with acute abdominal disorders (up to 6900 ng L-1). IL-6 on arrival to the ED was significantly correlated to the APACHE II sc ore (r = 0.48, P < 0.0001), LOS (r = 0.36, P < 0.0001) and was elevate d in nonsurvivors (n = 9) compared to those who did survive. TNF-alpha on arrival showed a significant correlation to LOS (r = 0.36, P < 0.0 001) and APACHE II (r = 0.41, P < 0.0001), but was not associated to l ater mortality. Conclusions. Serum levels of proinflammatory cytokines collected at admission to the ED were related to the severity of dise ase and hospital mortality.