• Plos One · Jan 2011

    Cytokine profiles in sepsis have limited relevance for stratifying patients in the emergency department: a prospective observational study.

    • Virginie Lvovschi, Laurent Arnaud, Christophe Parizot, Yonathan Freund, Gaëlle Juillien, Pascale Ghillani-Dalbin, Mohammed Bouberima, Martin Larsen, Bruno Riou, Guy Gorochov, and Pierre Hausfater.
    • Emergency Department, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France.
    • Plos One. 2011 Jan 1;6(12):e28870.

    IntroductionMorbidity, mortality and social cost of sepsis are high. Previous studies have suggested that individual cytokines levels could be used as sepsis markers. Therefore, we assessed whether the multiplex technology could identify useful cytokine profiles in Emergency Department (ED) patients.MethodsED patients were included in a single tertiary-care center prospective study. Eligible patients were >18 years and met at least one of the following criteria: fever, suspected systemic infection, ≥ 2 systemic inflammatory response syndrome (SIRS) criteria, hypotension or shock. Multiplex cytokine measurements were performed on serum samples collected at inclusion. Associations between cytokine levels and sepsis were assessed using univariate and multivariate logistic regressions, principal component analysis (PCA) and agglomerative hierarchical clustering (AHC).ResultsAmong the 126 patients (71 men, 55 women; median age: 54 years [19-96 years]) included, 102 had SIRS (81%), 55 (44%) had severe sepsis and 10 (8%) had septic shock. Univariate analysis revealed weak associations between cytokine levels and sepsis. Multivariate analysis revealed independent association between sIL-2R (p = 0.01) and severe sepsis, as well as between sIL-2R (p = 0.04), IL-1β (p = 0.046), IL-8 (p = 0.02) and septic shock. However, neither PCA nor AHC distinguished profiles characteristic of sepsis.ConclusionsPrevious non-multiparametric studies might have reached inappropriate conclusions. Indeed, well-defined clinical conditions do not translate into particular cytokine profiles. Additional and larger trials are now required to validate the limited interest of expensive multiplex cytokine profiling for staging septic patients.

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