Plasma cytokine levels predict response to corticosteroids in septic shock.

Abstract

PURPOSE:

To investigate if plasma cytokine concentrations predict a beneficial response to corticosteroid treatment in septic shock patients.

METHODS:

A cohort of septic shock patients in whom a panel of 39 cytokines had been measured at baseline (n = 363) was included. Patients who received corticosteroids were propensity score matched to non-corticosteroid-treated patients. An optimal threshold to identify responders to corticosteroid treatment for each cytokine was defined as the concentration above which the odds ratio for 28-day survival between corticosteroid- and non-corticosteroid-treated patients was highest.

RESULTS:

Propensity score matching partitioned 165 patients into 61 sets; each set contained matched corticosteroid- and non-corticosteroid-treated patients. For 13 plasma cytokines threshold concentrations were found where the odds ratio for survival between corticosteroid- and non-corticosteroid-treated patients was significant (P < 0.05). CD40 ligand was associated with the highest odds ratio and identified 21 % of the patients in the propensity score matched cohort as responders to corticosteroid treatment. Combinations of triplets of cytokines with a significant odds ratio, using the thresholds identified above, were tested to find a higher proportion of responders. IL3, IL6, and CCL4 identified 50 % of the patients in the propensity score matched cohort as responders to corticosteroid treatment. The odds ratio for 28-day survival was 19 (95 % CI 3.5-140, P = 0.02) with a concentration above threshold for a least one of these cytokines.

CONCLUSION:

Plasma concentration of selected cytokines is a potential predictive biomarker to identify septic shock patients that may benefit from treatment with corticosteroids.

• Authors: Peter Bentzer, Chris Fjell, Keith R Walley, John Boyd, James A Russell
• Journal: Intensive care medicine (Intensive Care Med) Vol. 42 Issue 12 Pg. 1970-1979 (Dec 2016) ISSN: 1432-1238 [Electronic] United States
• PMID: 27071387 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial)

Chemical References

• Adrenal Cortex Hormones
• Biomarkers
• Cytokines
• Vasoconstrictor Agents
• Vasopressins

Topics

• Adrenal Cortex Hormones (therapeutic use)
• Aged
• Biomarkers (blood)
• Case-Control Studies
• Cytokines (blood)
• Female
• Humans
• Male
• Middle Aged
• Odds Ratio
• Respiration, Artificial
• Shock, Septic (blood, mortality)
• Vasoconstrictor Agents (therapeutic use)
• Vasopressins