PROGNOSTIC VALUES OF TUMOR-NECROSIS-FACTOR CACHECTIN, INTERLEUKIN-1, INTERFERON-ALPHA, AND INTERFERON-GAMMA IN THE SERUM OF PATIENTS WITH SEPTIC SHOCK

Serum concentrations of immunoreactive tumor necrosis factor/cachectin (TNF), interleukin-1β (IL-1β), interferon-γ (IFNγ), and interferon-α (IFNα) were prospectively measured in 70 patients with septic shock to determine their evolution and prognostic values. In a univariate analysis, levels of TNF (P = .002) and IL-1β (P = .05) were associated with the patient's outcome, but not IFNα (P = .15) and IFNγ (P = .26). In contrast, in a stepwise logistic regression analysis, the severity of the underlying disease (P = .01), the age of the patient (P = .02), the documentation of infection (nonbacteremic infections vs. bacteremias, P = .03), the urine output (P = .04), and the arterial pH (P = .05) contributed more significantly to prediction of patient outcome than the serum levels of TNF (P = .07). After 10 days, the median concentration of TNF was undetectable (<100 pg/ml) in the survivors, whereas it remained elevated (305 pg/ml, P = .002) in the nonsurvivors. Thus, in patients with septic shock due to various gram-negative bacteria, other parameters than the absolute serum concentration of immunoreactive TNF contributed significantly to the prediction of outcome.