• Huang-Pin Wu, Chian-Kuang Chen, Kong Chung, Bor-Yiing Jiang, Teng-Jen Yu, and Duen-Yau Chuang.
• Division of Pulmonary Medicine, Department of Internal Medicine, and Department of Respiratory Therapy, Chang Gung Memorial Hospital, Keelung, and Chang Gung University College of Medicine, Taoyuan, Taiwan. whanpyng@cgmh.org.tw
• J Formos Med Assoc. 2009 Jan 1;108(1):20-7.

Background/PurposePro- and anti-inflammatory cytokines, such as interferon (IFN)-gamma, interleukin (IL)-6, IL-10, IL-12 and transforming growth factor (TGF)-beta1, have been shown to be mediators associated with severe community-acquired pneumonia (CAP). It is unknown whether plasma TGF-beta1 level can help physicians to judge disease severity. In this study, we investigated the value of predicting mortality in patients with severe CAP by the plasma levels of IFN-gamma, IL-6, IL-10, IL-12 and TGF-beta1 on admission day.MethodsPatients who were admitted to the emergency department and soon transferred to the ICU because of severe CAP were enrolled in this study. Plasma levels of IFN-gamma, IL-6, IL-10, IL-12 and TGF-beta1 on the day of admission were determined in 49 survivors and 14 non-survivors within 28 days by ELISA. Clinical characteristics were also recorded.ResultsPlasma IL-6, IL-10 and TGF-beta1 levels on admission were significantly different between survivors and non-survivors. Conversely, there was no significant difference in plasma IFN-gamma and IL-12 levels between the survivors and non-survivors. Furthermore, the plasma TGF-beta1 level was the only independent factor associated with mortality. The value of predicting mortality in patients with severe CAP was similar for IL-6, IL-10 and TGF-beta1. Plasma IL-6 level was not related to the Acute Physiology and Chronic Health Evaluation (APACHE) II score. However, plasma IL-10 and TGF-beta1 levels were correlated with APACHE II score.ConclusionA severity scoring system, including TGF-beta1 level on admission, may be considered as a useful parameter to predict outcomes of patients with severe CAP.

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