Clinical studies on cytokines in sepsis: role of serum cytokines in the development of multiple-systems organ failure.

The universal finding of a persistently elevated serum TNF level after 12 h in patients who go on to develop MSOF and die suggests that factors other than peak intensity of intravascular proinflammatory response determine survival. The persistence of elevated levels of TNF in the serum of patients who progress to MSOF suggests an aetiological relationship between continual activation of the immune response and remote organ dysfunction in critically ill patients.