PLASMA PATTERNS OF TUMOR-NECROSIS-FACTOR-ALPHA (TNF) AND TNF SOLUBLE RECEPTORS DURING ACUTE MENINGOCOCCAL INFECTIONS AND THE EFFECT OF PLASMA-EXCHANGE

In 39 patients with acute meningococcal infections, the plasma concent rations of tumor necrosis factor-alpha (TNF) and its soluble receptors (sRs) TNFsR-p55 and TNFsR-p75 were measured from admission till recov ery. At admission, patients with shock had significantly higher TNF, T NFsR-p55, and TNFsR-p75 values than patients without shock. In additio n, during the first 24 hours, patients with shock had higher TNFsR-p75 to TNFsR-p55 ratios, indicating that in shock the increase of TNFsR-p 75 exceeds that of TNFsR-p55, TNF measured more than 12 hours after ad mission failed to differentiate between shock and nonshock because TNF concentrations normalized within 12-24 hours. However, because concen trations of TNFsRs remained elevated for 5-6 days, at that time plasma TNFsRs still differentiated between shock and nonshock. Plasma exchan ge or whole blood exchange (PEBE), performed in 20 patients with shock , accelerated the decrease of plasma TNFsRs. However, because of a reb ound after each PEBE session, the overall half-lives of both TNFsRs we re not affected by PEBE.