Serum tumor necrosis factor levels in patients with infectious disease and septic shock
Offner, F.; Philippé, J.; Vogelaers, D.; Colardyn, F.; Baele, G.; Baudrihaye, M.; Vermeulen, A.; Leroux-Roels, G.
Journal of Laboratory and Clinical Medicine 116(1): 100-105
1990
ISSN/ISBN: 0022-2143 PMID: 2376691 Document Number: 353394
The role of tumor necrosis factor (TNF-.alpha.) in the pathogenesis of septic shock has been assessed by daily measurements of serum TNF-.alpha. levels in 60 patients admitted to the medical intensive care unit. All patients in the study had infectious disease and were at risk for the development of sepsis and septic shock. Sepsis was diagnosed in 34 patients, 24 of whom died (six within the first 24 hours). The 26 patients who did not evolve toward sepsis served as a control group. The clinical condition of all patients was monitored by daily APACHE II scoring. Blood was drawn once a day and additional samples were taken in patients whose clinical condition underwent sudden deterioration. TNF-.alpha. levels were measured with a commercially available immunoradiometric assay. At time of patient admission, TNF-.alpha. levels were higher in the group with sepsis than in the control group (median 79 iqr 329 vs median 0.5 iqr 5; p < 0.001). In the group with sepsis, extremely high TNF-.alpha. levels were found in patients who died within 24 hours. These patients had TNF-.alpha. levels of 917 iqr 755 pg/ml, whereas the patients who died more than 24 hours after admission had TNF-.alpha. levels of 58 iqr 59 pg/ml. Survivors had lower TNF-.alpha. levels (26 iqr 347 pg/ml). APACHE II scores correlated with TNF-.alpha. levels in the total sepsis group (Spearman rank correlation coefficient 0.477; p < 0.005). In patients who had sepsis, the onset of septic shock was not accompanied or followed by a sudden change in serum TNF-.alpha. levels. Instead, a persistent and constant elevation of TNF-.alpha. levels was seen.