Cytokine status in patients with sepsis
DOI:
https://doi.org/10.14739/2310-1210.2020.4.208375Keywords:
sepsis, septic shock, mortality, cytokineAbstract
Cytokines are specific proteins that are produced by lymphocytes. Cytokine production and release occurs rapidly and is rigorously controlled. Their activity is characterized by ensuring the interaction between cells and systems, regulation of inflammatory reactions and responsible for the development of autoimmune processes.
Patients with sepsis develop immunosuppression, when immune deficiency can progress to immunoparalysis. Cytokines cause effects similar to manifestations of acute and chronic infectious diseases having an ability to cause inflammation (pro-inflammatory) or inhibit the inflammatory process development (anti-inflammatory).
The aim of the work is to find out the dynamics of changes in the most important cytokines in patients with sepsis caused by diabetic foot syndrome.
Materials and methods. A total of 146 patients with sepsis who received treatment in the Zaporizhzhia Purulent-Septic Center with diabetic foot beds between 2006 and 2019 were examined and followed up.
Patients were distributed according to the forms of the disease: group 1 – 104 (71.2 %) patients with sepsis, group 2 – 42 (28.8 %) patients with septic shock. The average age of the patients was 62.8 ± 3.4 years, and the duration of type 2 diabetes mellitus was 12.3 ± 3.4 years. The groups were representative in terms of sex, age and concomitant pathology. The studies were conducted in dynamics: upon admission, on the 7–8th and 12–16th days of the postoperative period.
Results. The disease in sepsis patients was caused by wet gangrene of the lower extremities which occurred in 84.6 % of cases (88 patients). In 16 patients (15.4 %), the complications were caused by foot phlegmon and extended osteomyelitis. The cause of sepsis in patients with septic shock was wet gangrene of the extremities in 100 % of cases. Postoperative mortality in sepsis patients was 18.3%, and in patients with septic shock – 70.8 %.
The dynamics of changes in serum cytokines has been found to be indicative of these indicators imbalance which depends on the inflammatory process severity. The balance between cytokines is an important point in the regulation of inflammatory process onset and development. The course of the disease and its outcomes depend on this balance.
Conclusions. Determining the cytokine status is of great prognostic value because the level of pro- and anti-inflammatory cytokines, their ratio in patients with sepsis and septic shock reflects the intensity of alterative-destructive and regenerative-restorative processes as well as the dynamics and progression of the disease.
References
Park, D. W., & Zmijewski, J. W. (2017). Mitochondrial Dysfunction and Immune Cell Metabolism in Sepsis. Infection & Chemotherapy, 49(1), 10-21. https://doi.org/10.3947/ic.2017.49.1.10
Gao, F., Hui, J., Yang, L., Zhang, J., Yu, X., & Lu, S. (2019). Changes in Neutrophil Function in Septic Liver Injury and Its Effect on Prognosis: A Prospective Observational Study. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue, 31(11), 1324-1329. https://doi.org/10.3760/cma.j.issn.2095-4352.2019.11.003 [in Chinese].
Haas, L., Termorshuizen, F., de Lange, D. W., van Dijk, D., & de Keizer, N. F. (2020). Performance of the quick SOFA in very old ICU patients admitted with sepsis. Acta anaesthesiologica Scandinavica, 64(4), 508-516. https://doi.org/10.1111/aas.13536
Byrne, L., & Van Haren, F. (2017). Fluid resuscitation in human sepsis: Time to rewrite history? Annals of intensive care, 7(1), Article 4. https://doi.org/10.1186/s13613-016-0231-8
Liesenfeld, O., Lehman, L., Hunfeld, K. P., & Kost, G. (2014). Molecular diagnosis of sepsis: New aspects and recent developments. European journal of microbiology & immunology, 4(1), 1-25. https://doi.org/10.1556/EuJMI.4.2014.1.1
Mancini, N., Carletti, S., Ghidoli, N., Cichero, P., Burioni, R., & Clementi, M. (2010). The era of molecular and other non-culture-based methods in diagnosis of sepsis. Clinical microbiology reviews, 23(1), 235-251. https://doi.org/10.1128/CMR.00043-09
Prasad, P. A., Fang, M. C., Abe-Jones, Y., Calfee, C. S., Matthay, M. A., & Kangelaris, K. N. (2020). Time to Recognition of Sepsis in the Emergency Department Using Electronic Health Record Data: A Comparative Analysis of Systemic Inflammatory Response Syndrome, Sequential Organ Failure Assessment, and Quick Sequential Organ Failure Assessment. Critical care medicine, 48(2), 200-209. https://doi.org/10.1097/CCM.0000000000004132
Reyna, M. A., Josef, C. S., Jeter, R., Shashikumar, S. P., Westover, M. B., Nemati, S., Clifford, G. D., & Sharma, A. (2020). Early Prediction of Sepsis From Clinical Data: The PhysioNet/Computing in Cardiology Challenge 2019. Critical care medicine, 48(2), 210-217. https://doi.org/10.1097/CCM.0000000000004145
Rhodes, A., Evans, L. E., Alhazzani, W., Levy, M. M., Antonelli, M., Ferrer, R., Kumar, A., Sevransky, J. E., Sprung, C. L., Nunnally, M. E., Rochwerg, B., Rubenfeld, G. D., Angus, D. C., Annane, D., Beale, R. J., Bellinghan, G. J., Bernard, G. R., Chiche, J. D., Coopersmith, C., De Backer, D. P., … Dellinger, R. P. (2017). Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Intensive care medicine, 43(3), 304-377. https://doi.org/10.1007/s00134-017-4683-6
Seymour, C. W., Liu, V. X., Iwashyna, T. J., Brunkhorst, F. M., Rea, T. D., Scherag, A., Rubenfeld, G., Kahn, J. M., Shankar-Hari, M., Singer, M., Deutschman, C. S., Escobar, G. J., & Angus, D. C. (2016). Assessment of Clinical Criteria for Sepsis: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA, 315(8), 762-774. https://doi.org/10.1001/jama.2016.0288
Shankar-Hari, M., Phillips, G. S., Levy, M. L., Seymour, C. W., Liu, V. X., Deutschman, C. S., Angus, D. C., Rubenfeld, G. D., Singer, M., & Sepsis Definitions Task Force (2016). Developing a New Definition and Assessing New Clinical Criteria for Septic Shock: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA, 315(8), 775-787. https://doi.org/10.1001/jama.2016.0289
Shapoval, S. D., Vorontsova, L. L., Tribushniy, O. V., Savon, I. L., & Slobodchenko, L. Yu. (2016). Deiaki pokaznyky imunnoho statusu u khvorykh pry syndromi diabetychnoi stopy ta sepsysi [Some parameters of the immune state of patients with diabetic foot syndrome and sepsis]. Klinichna khirurhiia, (7), 30-32. [in Ukrainian].
Singer, M., Deutschman, C. S., Seymour, C. W., Shankar-Hari, M., Annane, D., Bauer, M., Bellomo, R., Bernard, G. R., Chiche, J. D., Coopersmith, C. M., Hotchkiss, R. S., Levy, M. M., Marshall, J. C., Martin, G. S., Opal, S. M., Rubenfeld, G. D., van der Poll, T., Vincent, J. L., & Angus, D. C. (2016). The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA, 315(8), 801-810. https://doi.org/10.1001/jama.2016.0287
Song, J., Park, D. W., Moon, S., Cho, H. J., Park, J. H., Seok, H., & Choi, W. S. (2019). Diagnostic and prognostic value of interleukin-6, pentraxin 3, and procalcitonin levels among sepsis and septic shock patients: a prospective controlled study according to the Sepsis-3 definitions. BMC infectious diseases, 19(1), Article 968. https://doi.org/10.1186/s12879-019-4618-7
Downloads
How to Cite
Issue
Section
License
Authors who publish with this journal agree to the following terms:- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access)