Markers of systemic inflammation predicting organ failure in community-acquired septic shock

To obtain predictors of organ failure (OF), we studied markers of systemic inflammation [circulating levels of interleukin-6 (IL-6), IL-8, soluble IL- 2 receptor (sIL-2R), soluble E-selectin and C-reactive protein, and neutrop hil and monocyte CD11b expression] and routine blood cell counts in 20 pati ents with system ic inflammatory response syndrome and positive blood cu It u re. Eight patients with shock due to community-acquired infection develop ed OF, whereas II normotensive patients and one patient with shock did not (NOF group). The fi rst blood sam pie was collected within 48 h after takin g the blood culture (TI). OF patients, as compared with NOF patients, had a t TI a lower monocyte count, a lower platelet count, higher levels of CD11b expression on both neutrophils and monocytes, and higher concentrations of IL-6, IL-8 and sIL-2R. C-reactive protein and soluble E-selectin concentra tions did not differ between groups. No parameter alone identified all pati ents that subsequently developed OF. However, a sepsisrelated inflammation severity score (SISS), developed on the basis of the presence or absence of shock and on the levels of markers at TI, identified each patient that dev eloped OF. The maximum SISS value was 7. The range of SISS values in OF pat ients was 2-5, and that in NOF patients was 0-1. In conclusion, high levels of CD11b expression, depressed platelet and monocyte counts, and high conc entrations of IL-6, IL-8 and sIL-2R predict OF in patients with community-a cquired septic shock, and the combination of these markers may provide the means to identify sepsis patients who will develop OF.