Diagnosis-Dependent Relationships between Cytokine Levels and Survival in Patients Admitted for Surgical Critical Care

Tjasa Hranjec, Brian R. Swenson, Lesly A. Dossett, Rosemarie Metzger, Tanya R. Flohr, Kimberley A. Popovsky, Hugo J. Bonatti, Addison K. May, Robert G. Sawyer

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Background: Death after trauma, infection, or other critical illness has been attributed to unbalanced inflammation, in which dysregulation of cytokines leads to multiple organ dysfunction and death. We hypothesized that admission cytokine profiles associated with death would differ based on admitting diagnosis. Study Design: This 5-year study included patients admitted for trauma or surgical intensive care for more than 48 hours at 2 academic, tertiary care hospitals between October 2001 and May 2006. Cytokine analysis for interleukin (IL)-1, -2, -4, -6, -8, -10, -12, interferon-γ, and tumor necrosis factor (TNF)-α was performed using ELISA on specimens drawn within 72 hours of admission. Mann-Whitney U test was used to compare median admission cytokine levels between alive and deceased patients. Relative risks and odds of death associated with admission cytokines were generated using univariate analysis and multivariate logistic regression models, respectively. Results: There were 1,655 patients who had complete cytokine data: 290 infected, nontrauma; 343 noninfected, nontrauma; and 1,022 trauma. Among infected patients, nonsurvivors had higher median admission levels of IL-2, -8, -10, and granulocyte macrophage-colony stimulating factor; noninfected, nontrauma patients had higher IL-6, -8, and IL-10; and nonsurviving trauma patients had higher IL-4, -6, -8, and TNF-α. IL-4 was the most significant predictor of death and carried the highest relative risk of dying in trauma patients, and IL-8 in nontrauma, noninfected patients. In infected patients, no cytokine independently predicted death. Conclusions: Cytokine profiles of certain disease states may identify persons at risk of dying and allow for selective targeting of multiple cytokines to prevent organ dysfunction and death.

Original languageEnglish (US)
Pages (from-to)833-844
Number of pages12
JournalJournal of the American College of Surgeons
Volume210
Issue number5
DOIs
StatePublished - May 2010

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Critical Care
Cytokines
Survival
Interleukin-8
Wounds and Injuries
Interleukin-4
Interleukin-2
Interleukin-6
Tumor Necrosis Factor-alpha
Logistic Models
Tertiary Healthcare
Granulocyte-Macrophage Colony-Stimulating Factor
Nonparametric Statistics
Interleukin-1
Tertiary Care Centers
Critical Illness
Interleukin-10
Interferons
Multivariate Analysis
Enzyme-Linked Immunosorbent Assay

ASJC Scopus subject areas

  • Surgery

Cite this

Diagnosis-Dependent Relationships between Cytokine Levels and Survival in Patients Admitted for Surgical Critical Care. / Hranjec, Tjasa; Swenson, Brian R.; Dossett, Lesly A.; Metzger, Rosemarie; Flohr, Tanya R.; Popovsky, Kimberley A.; Bonatti, Hugo J.; May, Addison K.; Sawyer, Robert G.

In: Journal of the American College of Surgeons, Vol. 210, No. 5, 05.2010, p. 833-844.

Research output: Contribution to journalArticle

Hranjec, T, Swenson, BR, Dossett, LA, Metzger, R, Flohr, TR, Popovsky, KA, Bonatti, HJ, May, AK & Sawyer, RG 2010, 'Diagnosis-Dependent Relationships between Cytokine Levels and Survival in Patients Admitted for Surgical Critical Care', Journal of the American College of Surgeons, vol. 210, no. 5, pp. 833-844. https://doi.org/10.1016/j.jamcollsurg.2009.12.042
Hranjec, Tjasa ; Swenson, Brian R. ; Dossett, Lesly A. ; Metzger, Rosemarie ; Flohr, Tanya R. ; Popovsky, Kimberley A. ; Bonatti, Hugo J. ; May, Addison K. ; Sawyer, Robert G. / Diagnosis-Dependent Relationships between Cytokine Levels and Survival in Patients Admitted for Surgical Critical Care. In: Journal of the American College of Surgeons. 2010 ; Vol. 210, No. 5. pp. 833-844.
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abstract = "Background: Death after trauma, infection, or other critical illness has been attributed to unbalanced inflammation, in which dysregulation of cytokines leads to multiple organ dysfunction and death. We hypothesized that admission cytokine profiles associated with death would differ based on admitting diagnosis. Study Design: This 5-year study included patients admitted for trauma or surgical intensive care for more than 48 hours at 2 academic, tertiary care hospitals between October 2001 and May 2006. Cytokine analysis for interleukin (IL)-1, -2, -4, -6, -8, -10, -12, interferon-γ, and tumor necrosis factor (TNF)-α was performed using ELISA on specimens drawn within 72 hours of admission. Mann-Whitney U test was used to compare median admission cytokine levels between alive and deceased patients. Relative risks and odds of death associated with admission cytokines were generated using univariate analysis and multivariate logistic regression models, respectively. Results: There were 1,655 patients who had complete cytokine data: 290 infected, nontrauma; 343 noninfected, nontrauma; and 1,022 trauma. Among infected patients, nonsurvivors had higher median admission levels of IL-2, -8, -10, and granulocyte macrophage-colony stimulating factor; noninfected, nontrauma patients had higher IL-6, -8, and IL-10; and nonsurviving trauma patients had higher IL-4, -6, -8, and TNF-α. IL-4 was the most significant predictor of death and carried the highest relative risk of dying in trauma patients, and IL-8 in nontrauma, noninfected patients. In infected patients, no cytokine independently predicted death. Conclusions: Cytokine profiles of certain disease states may identify persons at risk of dying and allow for selective targeting of multiple cytokines to prevent organ dysfunction and death.",
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T1 - Diagnosis-Dependent Relationships between Cytokine Levels and Survival in Patients Admitted for Surgical Critical Care

AU - Hranjec, Tjasa

AU - Swenson, Brian R.

AU - Dossett, Lesly A.

AU - Metzger, Rosemarie

AU - Flohr, Tanya R.

AU - Popovsky, Kimberley A.

AU - Bonatti, Hugo J.

AU - May, Addison K.

AU - Sawyer, Robert G.

PY - 2010/5

Y1 - 2010/5

N2 - Background: Death after trauma, infection, or other critical illness has been attributed to unbalanced inflammation, in which dysregulation of cytokines leads to multiple organ dysfunction and death. We hypothesized that admission cytokine profiles associated with death would differ based on admitting diagnosis. Study Design: This 5-year study included patients admitted for trauma or surgical intensive care for more than 48 hours at 2 academic, tertiary care hospitals between October 2001 and May 2006. Cytokine analysis for interleukin (IL)-1, -2, -4, -6, -8, -10, -12, interferon-γ, and tumor necrosis factor (TNF)-α was performed using ELISA on specimens drawn within 72 hours of admission. Mann-Whitney U test was used to compare median admission cytokine levels between alive and deceased patients. Relative risks and odds of death associated with admission cytokines were generated using univariate analysis and multivariate logistic regression models, respectively. Results: There were 1,655 patients who had complete cytokine data: 290 infected, nontrauma; 343 noninfected, nontrauma; and 1,022 trauma. Among infected patients, nonsurvivors had higher median admission levels of IL-2, -8, -10, and granulocyte macrophage-colony stimulating factor; noninfected, nontrauma patients had higher IL-6, -8, and IL-10; and nonsurviving trauma patients had higher IL-4, -6, -8, and TNF-α. IL-4 was the most significant predictor of death and carried the highest relative risk of dying in trauma patients, and IL-8 in nontrauma, noninfected patients. In infected patients, no cytokine independently predicted death. Conclusions: Cytokine profiles of certain disease states may identify persons at risk of dying and allow for selective targeting of multiple cytokines to prevent organ dysfunction and death.

AB - Background: Death after trauma, infection, or other critical illness has been attributed to unbalanced inflammation, in which dysregulation of cytokines leads to multiple organ dysfunction and death. We hypothesized that admission cytokine profiles associated with death would differ based on admitting diagnosis. Study Design: This 5-year study included patients admitted for trauma or surgical intensive care for more than 48 hours at 2 academic, tertiary care hospitals between October 2001 and May 2006. Cytokine analysis for interleukin (IL)-1, -2, -4, -6, -8, -10, -12, interferon-γ, and tumor necrosis factor (TNF)-α was performed using ELISA on specimens drawn within 72 hours of admission. Mann-Whitney U test was used to compare median admission cytokine levels between alive and deceased patients. Relative risks and odds of death associated with admission cytokines were generated using univariate analysis and multivariate logistic regression models, respectively. Results: There were 1,655 patients who had complete cytokine data: 290 infected, nontrauma; 343 noninfected, nontrauma; and 1,022 trauma. Among infected patients, nonsurvivors had higher median admission levels of IL-2, -8, -10, and granulocyte macrophage-colony stimulating factor; noninfected, nontrauma patients had higher IL-6, -8, and IL-10; and nonsurviving trauma patients had higher IL-4, -6, -8, and TNF-α. IL-4 was the most significant predictor of death and carried the highest relative risk of dying in trauma patients, and IL-8 in nontrauma, noninfected patients. In infected patients, no cytokine independently predicted death. Conclusions: Cytokine profiles of certain disease states may identify persons at risk of dying and allow for selective targeting of multiple cytokines to prevent organ dysfunction and death.

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