The relationship between
cytokines and
sepsis has been studied frequently in the intensive care unit (ICU). However, the determination of
cytokines in patients as they enter the emergency department (ED) would be more meaningful in predicting the outcome of
infection. This study investigated plasma
interleukin-8 in the ED as the predictor of
bacteremia and
sepsis. One hundred patients admitted through the ED with signs of
systemic inflammatory response syndrome were studied. Plasma
IL-8,
IL-6, and
tumor necrosis factor (TNF) were assayed by
enzyme-linked
immunosorbent assay. Patient's data were evaluated using the APACHE II scoring system as predictive factors of morbidity and mortality. Plasma
IL-8 (149 pg/mL) detected
bacteremia with a positive predictive value of 90.9% and a specificity of 98.7%. Results indicated that the odds ratios (
ORs) of
bacteremia were 24.78 (P < 0.01, CI = 2.27-270.8), 5.42 (P < 0.05, CI = 1.37-21.4), and 6.05 (P < 0.05, CI = 1.36-26.8) for
IL-8,
IL-6, and APACHE II, respectively. Occurrence of
bacteremia was highly correlated with increases in plasma
IL-8 (P < 0.01).
IL-8 (OR = 8.25, CI = 1.03-65.9) and APACHE II scores (OR = 12.6, CI = 2.24-70.4) were found to be significantly better predictive factors of mortality (P < 0.01) than
IL-6 (OR = 3.60, CI = 0.57-22.7), TNF (OR = 0.24, CI = 0.01-11.0) and age (OR = 1.02, CI = 0.98-1.06). During
bacteremia,
IL-8 also correlated well with patient use of a
ventilator (P < 0.01, OR = 2.43, CI = 2.41-311.19), use of vasopressors (P < 0.05, OR = 2.67, CI = 1.79-370.78),
length of stay in the hospital (P < 0.01, OR = 3.14, CI = 1.87-988.31), and stay in the ICU (P < 0.01, OR = 2.51, CI = 2.98-449.80). Measuring
IL-8 on patients in the ED with apparent
bacterial infections appears to be a reliable predictor of
bacteremia and the severity of disease.