Prospective study of two cohorts of patients.
SETTING: High concentrations of circulating
TNF-alpha and
IL-6 were found in patients with
septic shock. High
IL-6 concentrations, but normal
TNF-alpha concentrations were detected in
trauma patients. At study entry,
TNF-alpha concentrations were higher in nonsurvivor
septic shock than in nonsurvivor
trauma patients (42 +/- 7 vs 13 +/- 2 pg/mL; p < .001). During the whole study period, nonsurvivor
septic shock patients maintained higher
TNF-alpha concentrations than nonsurvivor
trauma patients (p < .001). In survivors in both groups, normal values for
TNF-alpha were detected during the whole study period. At study entry,
IL-6 concentrations were significantly higher in nonsurvivor
septic shock patients than in nonsurvivor
trauma patients (15,627 +/- 4336 vs. 317 +/- 124 pg/mL; p < .0001). During the whole study period, much higher concentrations of
IL-6 were detected in
septic shock patients than in
trauma patients (p < .0001). In survivors, at study entry,
IL-6 concentrations were much higher in
septic shock patients than in
trauma patients (3947 +/- 1410 vs. 247 +/- 41 pg/mL; p < .001). Higher
IL-6 concentrations were maintained throughout the study period in
septic shock patients than in
trauma patients (p < .001). In
septic shock patients, changes in both
TNF-alpha and
IL-6 were correlated with outcome, higher values being found in patients likely to die. Neither
TNF-alpha nor
IL-6 values were of any significant value in predicting outcome of
trauma patients. When
septic shock patients were compared with traumatized patients resuscitated from
hemorrhagic shock, the former had much higher concentrations of both
TNF-alpha and
IL-6 throughout the study period (p < .01 to p < .00001). Increased
IL-6 values were an
indicator of the development of a
nosocomial infection in
trauma patients. In five
trauma patients who developed a
nosocomial pneumonia during the study period, the
IL-6 concentration was 433 +/- 385 pg/mL before the onset of
pneumonia, then peaked
at 3970 +/- 1478 pg/mL on day 7, and returned to baseline (219 +/- 58 pg/mL) on day 11.
CONCLUSIONS: