Dynamic changes and prognostic significance of inflammatory factors in patients with severe sepsis

Objective To detect the change of the concentration of serum inflammatory cytokines of sepsis patients with different severity grades, and to explore the relationship between cytokines and severity as well as prognosis. Methods Twenty-two severe sepsis patients and 34 septic shock patients were collected from October 2010 to October 2013 at the China-Japan Friendship Hospital Emergency Department. Venous blood samples were collected to assay concentration of cytokines TNF-α, IL-6 and PAF at 5 intervals, when patients were admitted to hospital, 6 hours, 24 hours, 72 hours and 168 hours after admission. Besides, another 51 healthy adults were recruited as control group for comparison with patient group. The diagnosis of severe sepsis and septic shock were based on 2012 serious sepsis and septic shock treatment guidelines. Patients with history of malignant tumor, autoimmune diseases and AIDS were excluded, as well as patients under 18 years old and died within 24 hours. Enzyme-linked immunosorbent assay (ELISA) was employed to determine the concentration of inflammatory cytokines, variance analysis was used for group comparison between groups; and patients were divided into survival group and death group according to the patient outcome in 28 days. The changes of cytokines at different intervals were compared and its relationship between the severity and prognosis were analyzed, andt test was used for comparison between groups. Results Concentrations of cytokines on admission of severe sepsis and septic shock group were significantly higher than those of the control group; TNF-α were (26.08±7.36) pg/ mL, (54.14±13.56) pg/ mLvs. (19.52±3.44) pg/ mL; IL-6 were (39.52±9.52) pg/ mL, (49.03±10.31) pg/ mLvs. (20.46±6.39) pg/ mL, PAF were (80.13±20.43) pg/ mL, (135.5±23.45) pg/ mLvs. (57.32±19.11) pg/ mL, the differences were statistically significant (P<0.05).The concentrations of cytokines in septic shock group were higher than those of severe sepsis group at all intervals, the differences were statistically significant (P<0.05).Concentrations of cytokines in death group were higher than those in the survival group at all intervals; the differences were statistically significant (P<0.05). The serum concentrations of TNF-α and IL-6 reached peak 6 hours after admission, and PAF serum concentration peaked at admission time. Then a trend of decline was occurred in all cytokines in a parallel way. Conclusions The concentrations of relevant cytokines were positively associated with the severity grade of patients with sepsis. The trends of changes in cytokines in patients with different severity grades and prognosis were similar. Concentration of TNF-α, IL-6 and PAF in the patients with sepsis can provide some clue for evaluating the status of illness and prognosis. Key words: Sepsis; TNF-α; IL-6; PAF; Dynamic change