Predictive value of nuclear factor kappa B activity and plasma cytokine levels in patients with sepsis

The relationship between fluctuating cytokine concentrations in plasma and the outcome of sepsis is complex. We postulated that early measurement of t he activation of nuclear factor kappa B (NF-kappa B), a transcriptional reg ulatory protein involved in proinflammatory cytokine expression, may help t o predict the outcome of sepsis. We determined NF-kappa B activation in per ipheral blood mononuclear cells of 34 patients with severe sepsis (23 survi vors and 11 nonsurvivors) and serial concentrations of inflammatory cytokin es (interleukin-6, interleukin-1, and tumor necrosis factor) and various en dogenous antagonists in plasma. NF-kappa B activity was significantly highe r in nonsurvivors and correlated strongly with the severity of illness (APA CHE II score), although neither was related to the cytokine levels, Apart f rom NF-kappa B activity, the interleukin-1 receptor antagonist was the only cytokine tested whose level in plasma was of value in predicting mortality bs logistic regression analysis. These results underscore the prognostic v alue of early measurement of NF-kappa B activity in patients with severe se psis.