Prognostic value of cytokine concentrations (tumor necrosis factor-alpha, interleukin-6, and interleukin-10) and clinical parameters in severe melioidosis

Raised serum concentrations of tumor necrosis factor (TNF)-alpha, interleuk in (IL)-1 beta, IL-6, or IL-10 are associated with mortality in patients wi th sepsis, but it is not known whether elevated cytokine levels are indepen dently predictive of mortality. Cytokine assays (TNF-alpha, IL-6, and IL-10 ) were performed on admission plasma samples from 172 adult Thai patients w ith severe melioidosis. Mortality was 31.4%. APACHE II score; septicemia; p lasma lactate; TNF-alpha, IL-6, and IL-10 concentrations; and IL-10/TNF-alp ha and IL-6/IL-10 ratios were each associated with outcome (P less than or equal to .001 for all variables). Only the APACHE II score and either IL-6 or IL-10 concentration were independent predictors of mortality, as determi ned by use of multiple logistic regression (with cytokine concentrations an d ratios entered separately). In a multivariate analysis, including both IL -6 and IL-10, the IL-10 concentration was no longer predictive. Therefore, APACHE II scores and either IL-6 or IL-10 concentration may be the most rel iable parameters for stratification of patients in future studies of severe gramnegative sepsis.