PILOT-STUDY OF CYTOKINES IN EMERGENCY DEPARTMENT PATIENTS WITH SYSTEMIC INFLAMMATORY RESPONSE SYNDROME

Objective: To determine the potential utility of cytokine and arachido nic acid metabolite levels in ED patients with systemic inflammatory r esponse syndrome (SIRS) as a predictor of progression to severe sepsis . Methods: A prospective, observational study of test performance was performed using convenience samples of adult control subjects and admi tted patients. The latter patients were identified in the ED as having signs of SIRS. Levels of cytokines and arachidonic acid metabolites m easured from specimens obtained in the ED were compared between groups and associated with the progression of sepsis within 24 hours in the SIRS patients. Results: There were 30 control patients and 29 SIRS pat ients. There were 8 SIRS subjects who progressed to severe sepsis with in 24 hours using the following criteria (hypotension, n = 5; hypoperf usion, n = 1; and organ dysfunction, n = 2). Of the 21 SIRS subjects w ho did not progress to severe sepsis, 11 had resolution of SIRS criter ia at 24 hours. There were no significant differences in mean mediator levels between the SIRS patients who progressed to severe sepsis and those who did not. Of the 11 patients with resolution of SIRS criteria at 24 hours, the mean interleukin-6 (IL-6) level was significantly lo wer than that for the patients who did not recover or who progressed a t 24 hours (n = 18); 65.4 +/- 49.1 vs 230 +/- 112 pg/mL, p = 0.001). S ix of 15 subjects with IL-6 >150 pg/mL progressed to severe sepsis (p = NS). Using threshold values based on the range of levels for normals , the sensitivity of an abnormal marker for the development of severe sepsis within 24 hours varied from 50% to 87%, while the specificity v aried from 11% to 84%. Conclusion: While mean levels were significantl y elevated when compared with those of normal control subjects, they h ad limited ability to predict the subset of patients likely to progres s to severe sepsis. However, initial low levels of cytokines may have exclusionary prognostic value. Prospective validation of the latter fi nding is warranted.