The compensatory anti-inflammatory cytokine interleukin 10 response in pediatric sepsis-induced multiple organ failure

被引:78
作者
Doughty, L
Carcillo, JA
Kaplan, S
Janosky, J
机构
[1] Wilford Hall USAF Med Ctr, Dept Pediat, Lackland AFB, TX 78236 USA
[2] Univ Pittsburgh, Sch Med, Dept Anesthesiol & Crit Care Med, Ctr Clin Pharmacol, Pittsburgh, PA 15260 USA
关键词
children; compensatory anti-inflammatory response syndrome; interleukin; 6; 10; multiple organ failure; nitric oxide; sepsis;
D O I
10.1378/chest.113.6.1625
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Study objectives: To determine the circulating anti-inflammatory cytokine interleukin 10 (IL-10) response during the development of sepsis-induced multiple organ failure in children. Design: Prospective study. Setting: University pediatric ICU. Patients: Fifty-three consecutive children with sepsis and 15 critically ill children without sepsis, Interventions: Plasma IL-10, interleukin 6 (IL-6), and nitrite+nitrate (stable end products of nitric oxide) levels and an organ failure index (OFI indicating the number of failing organ systems) were determined in 53 children on days 1 to 3 of sepsis and in control children on day 1. The effect of exogenous human IL-10 or neutralizing IL-10 antibody on supernatant IL-6 levels in ex vivo whole blood culture from 17 children on day 1 of sepsis, Measurements ana results: Children with three or more organ failures had higher plasma IL-10 levels than children with less than 3 organ failures (days 1 and 3; p<0.05). Children who developed sequential pulmonary/hepatic/renal failure had higher IL-10 levels (days 1 to 3; p< 0.05), Nonsurvivors had higher IL-10 levels (day 3; p<0.05). IL-10 levels correlated with IL-6 levels (days 1 and 2) and nitrite+nitrate levels (days 1 and 3; p<0.05), Whole blood samples incubated ex vivo with exogenous recombinant human IL-10 had decreased supernatant IL-6 levels (p<0.05) and neutralizing IL-10 antibody showed no significant effect. Conclusion: A persistent compensatory anti-inflammatory cytokine response characterizes sepsis-induced multiple organ failure. Administration of exogenous IL-10 may inhibit the early proinflammatory response; however, identification of individual immune responsiveness and possibility of persistent infection could be Important to rational use in the later stages of pediatric sepsis.
引用
收藏
页码:1625 / 1631
页数:7
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