Cecilia Gómez Ravetti1, Anselmo Dornas Moura2, Érica Leandro Vieira3, Ênio Roberto Pietra Pedroso4, Antônio Lúcio Teixeira3. 1. Postgraduate Program in Health Sciences: Infectology and Tropical Medicine, Department of Internal Medicine, School of Medicine, UFMG, Belo Horizonte, Minas Gerais, Brazil; ICU of Mater Dei Hospital, Belo Horizonte, Minas Gerais, Brazil. Electronic address: ceciliag.ravetti@gmail.com. 2. ICU of Mater Dei Hospital, Belo Horizonte, Minas Gerais, Brazil. 3. Postgraduate Program in Health Sciences: Infectology and Tropical Medicine, Department of Internal Medicine, School of Medicine, UFMG, Belo Horizonte, Minas Gerais, Brazil; Interdisciplinary Laboratory of Medical Investigation, School of Medicine, UFMG, Belo Horizonte, Minas Gerais, Brazil. 4. Postgraduate Program in Health Sciences: Infectology and Tropical Medicine, Department of Internal Medicine, School of Medicine, UFMG, Belo Horizonte, Minas Gerais, Brazil.
Abstract
INTRODUCTION: The innate immune response molecules and their use as a predictor of mortality in cancer patients with severe sepsis and septic shock are poorly investigated. OBJECTIVE: To analyze the value of interleukin (IL)-1ß, IL-6, IL-8, IL-10, IL-12, tumor necrosis factor α (TNF-α), soluble triggering receptor expressed on myeloid cells 1 (sTREM-1), and high-mobility group box 1 (HMGB-1) as predictors of mortality in cancer patients with severe sepsis and septic shock compared with septic patients without malignancies. DESIGN: Prospective, observational cohort study. SETTING: Tertiary level adult intensive care unit (ICU). SUBJECTS: Seventy-five patients with severe sepsis or septic shock, 40 with cancer and 35 without. INTERVENTIONS AND MEASUREMENTS: Laboratory data were collected at ICU admission, 24 and 48 hours after. Plasma concentrations of HMGB-1 and sTREM-1 were measured by enzyme-linked immunosorbent assay, whereas cytokines were measured by cytometric bead array. RESULTS: Intensive care unit mortality in cancer and noncancer patients was 40% and 28.6% (P = .29), and 28-day mortality was 45% and 34.3% (P = .34). Proinflammatory cytokines IL-1ß, IL-6, IL-8, IL-12, and TNF-α showed significantly higher values in the cancer group. Interleukin-10 at 48 hours (P = .01), sTREM-1 in all measurements (P < .01) and HMGB-1 at 24 hours (P < .01) showed significantly lower values in the cancer group. In addition, for the cancer group, sTREM-1 at 24 hours (P = .02) and 48 hours (P = .01) showed higher levels in nonsurvivors patients. The area under the receiver operating characteristic curve for predicting ICU mortality for sTREM-1 was 0.73 (95% confidence interval, 0.57-0.89; P = .01). Multivariate logistic analysis showed that the days spent in mechanical ventilation and levels of sTREM-1 and IL-1ß at 48 hours were independent predictors of ICU mortality; corticosteroids requirement and levels of sTREM-1 and TNF-α at 24 hours were independent predictors of 28-day mortality. CONCLUSIONS: Patients with cancer have different immune profile in sepsis when compared with patients without cancer, as demonstrated for levels of cytokines, sTREM-1 and HMGB-1. sTREM-1 and days spent in mechanical ventilation proved to be good predictors of ICU and 28-day mortality in cancer patients.
INTRODUCTION: The innate immune response molecules and their use as a predictor of mortality in cancerpatients with severe sepsis and septic shock are poorly investigated. OBJECTIVE: To analyze the value of interleukin (IL)-1ß, IL-6, IL-8, IL-10, IL-12, tumor necrosis factor α (TNF-α), soluble triggering receptor expressed on myeloid cells 1 (sTREM-1), and high-mobility group box 1 (HMGB-1) as predictors of mortality in cancerpatients with severe sepsis and septic shock compared with septicpatients without malignancies. DESIGN: Prospective, observational cohort study. SETTING: Tertiary level adult intensive care unit (ICU). SUBJECTS: Seventy-five patients with severe sepsis or septic shock, 40 with cancer and 35 without. INTERVENTIONS AND MEASUREMENTS: Laboratory data were collected at ICU admission, 24 and 48 hours after. Plasma concentrations of HMGB-1 and sTREM-1 were measured by enzyme-linked immunosorbent assay, whereas cytokines were measured by cytometric bead array. RESULTS: Intensive care unit mortality in cancer and noncancer patients was 40% and 28.6% (P = .29), and 28-day mortality was 45% and 34.3% (P = .34). Proinflammatory cytokines IL-1ß, IL-6, IL-8, IL-12, and TNF-α showed significantly higher values in the cancer group. Interleukin-10 at 48 hours (P = .01), sTREM-1 in all measurements (P < .01) and HMGB-1 at 24 hours (P < .01) showed significantly lower values in the cancer group. In addition, for the cancer group, sTREM-1 at 24 hours (P = .02) and 48 hours (P = .01) showed higher levels in nonsurvivors patients. The area under the receiver operating characteristic curve for predicting ICU mortality for sTREM-1 was 0.73 (95% confidence interval, 0.57-0.89; P = .01). Multivariate logistic analysis showed that the days spent in mechanical ventilation and levels of sTREM-1 and IL-1ß at 48 hours were independent predictors of ICU mortality; corticosteroids requirement and levels of sTREM-1 and TNF-α at 24 hours were independent predictors of 28-day mortality. CONCLUSIONS:Patients with cancer have different immune profile in sepsis when compared with patients without cancer, as demonstrated for levels of cytokines, sTREM-1 and HMGB-1. sTREM-1 and days spent in mechanical ventilation proved to be good predictors of ICU and 28-day mortality in cancerpatients.