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Evaluation of tumor necrosis factor-α, interleukin-6 and C-reactive protein plasma levels as predictors of bacteremia in patients presenting signs of sepsis without shock

1997; Elsevier BV; Volume: 3; Issue: 3 Linguagem: Inglês

10.1111/j.1469-0691.1997.tb00618.x

1469-0691

B. Byl, Jacques Devière, Francis Saint-Hubert, Francis Zech, Béatrice Gulbis, J.P. Thys,

Nosocomial Infections in ICU

Objective: To evaluate the sensitivity of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) plasma measurement to detect bacteremia in patients presenting sepsis signs, and to evaluate the potential benefit of such measurement in terms of early antimicrobial therapy initiation.Methods: Plasma was obtained from 166 hospitalized patients for whom blood cultures were drawn for sepsis. Clinical data and antimicrobial therapies were noted. IL-6, TNF and C-reactive protein (CRP) were measured. The sensitivities of these markers were retrospectively compared with the accuracy of the attending physician in initiating empirical antimicrobial therapy. The setting was an 850-bed university hospital.Results: Thirty-four bacteremias and 69 non-bacteremic infections were noted. In 63 others, no infection was documented. Median (range) IL-6 plasma levels in the three groups of patients were 462 (15–50 850), 189 (<15–38 300) and 91 (<10–13 750) pg/mL, respectively (p<0.01). The corresponding TNF-α plasma levels were 37.5 (<15–2400), 15 (<15–240) and 15 (<15–200) pg/mL, respectively (p<0.01). CRP plasma levels were 10.7 (<0.6–30.2), 10.3 (<0.6–34.4) and 7.3 ( 200 pg/mL). A combination of clinical features and high IL-6 levels would have permitted early treatment for 82% of the bacteremic patients.Conclusions: IL-6 and TNF-α thus appear to be useful and earlier markers of bacteremia in septic patients. By contrast, CRP is neither sensitive nor specific in this setting. Objective: To evaluate the sensitivity of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) plasma measurement to detect bacteremia in patients presenting sepsis signs, and to evaluate the potential benefit of such measurement in terms of early antimicrobial therapy initiation. Methods: Plasma was obtained from 166 hospitalized patients for whom blood cultures were drawn for sepsis. Clinical data and antimicrobial therapies were noted. IL-6, TNF and C-reactive protein (CRP) were measured. The sensitivities of these markers were retrospectively compared with the accuracy of the attending physician in initiating empirical antimicrobial therapy. The setting was an 850-bed university hospital. Results: Thirty-four bacteremias and 69 non-bacteremic infections were noted. In 63 others, no infection was documented. Median (range) IL-6 plasma levels in the three groups of patients were 462 (15–50 850), 189 (<15–38 300) and 91 (<10–13 750) pg/mL, respectively (p<0.01). The corresponding TNF-α plasma levels were 37.5 (<15–2400), 15 (<15–240) and 15 (<15–200) pg/mL, respectively (p<0.01). CRP plasma levels were 10.7 (<0.6–30.2), 10.3 (<0.6–34.4) and 7.3 ( 200 pg/mL). A combination of clinical features and high IL-6 levels would have permitted early treatment for 82% of the bacteremic patients. Conclusions: IL-6 and TNF-α thus appear to be useful and earlier markers of bacteremia in septic patients. By contrast, CRP is neither sensitive nor specific in this setting.