• Yao-Ling Lee, Wei Chen, Ling-Yun Chen, Chia-Hung Chen, Yu-Chao Lin, Shinn-Jye Liang, and Chuen-Ming Shih.
• School of Medical Laboratory and Biotechnology, Chung Shan Medical University, 402 Taichung, Taiwan.
• J Crit Care. 2010 Mar 1;25(1):176.e7-13.

ObjectivesThe aim of this study was to determine whether cytokine expression (interleukin [IL]-1beta, IL-6, IL-8, IL-10, and tumor necrosis factor [TNF]-alpha), C-reactive protein, and endotoxins on the first day of intensive care unit (ICU) admission are associated with hospital mortality in severe community-acquired pneumonia (CAP).DesignThis was a prospective study with bronchoalveolar lavage (BAL) and blood sampling.SettingThis study was carried out in a 44-bed medical ICU of a 1700-bed university hospital.PatientsParticipants included 112 mechanically ventilated patients with severe CAP.InterventionsSerum and BAL fluid IL-1beta, IL-6, IL-8, IL-10, TNF-alpha, C-reactive protein, and endotoxins on the first day of ICU admission were obtained.Measurements And Main ResultsThe concentrations of TNF-alpha in BALF and IL-6, IL-8, IL-10, and TNF-alpha in serum were higher in nonsurvivors than in survivor patients with CAP. Of these 112 patients with severe CAP (39%), 44 developed acute respiratory distress syndrome (ARDS); these patients seemed to have higher serum IL-6, IL-8, and IL-10 levels than did the non-ARDS group. Furthermore, in the ARDS population, we found that the endotoxin levels in the BAL fluid were higher in the survival than in the nonsurvival group and BAL fluid concentrations of IL-6, IL-8, and IL-1beta and sera levels of IL-6 and IL-10 were lower in the survival than in the nonsurvival group, and they were associated with a high negative predictive value.ConclusionsSerum and BAL fluid levels of the studied cytokines on admission may provide valuable prognostic information for patients with severe CAP.Copyright 2010 Elsevier Inc. All rights reserved.

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