Thorax 2000;55:46-52 ( January )

Comparison of systemic cytokine levels in patients with acute respiratory distress syndrome, severe pneumonia, and controls

Torsten T Bauer^a, Concepción Montón^a, Antoni Torres^a, Hernan Cabello^a, Xavier Fillela^b, Abel Maldonado^a, Jose-Maria Nicolás^c, Elisabet Zavala^d

^a Servei de Pneumologia I Al.lèrgia Respiratoria, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain, ^b Servei de Bioquímica, ^c Area de Vigilancia Intensiva, ^d UCI Quirúrgica

Correspondence to: Dr A Torres, Hospital Clinic I Provincial, Servei de Pneumologia I Al.lèrgia Respiratoria, Villarroel 170, E-08036 Barcelona, Spain

Received 5 March 1999; Returned to authors 11 June 1999; Revised version received 28 July 1999; Accepted for publication 7 September 1999

BACKGROUNDThe inflammatory response has been widely investigated in patients with acute respiratory distress syndrome (ARDS) and pneumonia. Studies investigating the diagnostic values of serum cytokine levels have yielded conflicting results and only little information is available for the differential diagnosis between ARDS and pneumonia.
METHODSClinical and physiological data, serum concentrations of tumour necrosis factor (TNF)-, interleukin (IL)-1 and IL-6, and quantitative cultures of lower respiratory tract specimens were obtained from 46 patients with ARDS and 20 with severe pneumonia within 24 hours of the onset of the disease and from 10 control subjects with no inflammatory lung disease. Cytokine concentrations were compared between groups and determinants in addition to the diagnosis were tested.
RESULTSSerum TNF- levels were significantly higher in ARDS patients (67 (57) pg/ml) than in patients with severe pneumonia (35 (20) pg/ml; p = 0.031) or controls (17 (8) pg/ml; p = 0.007). For IL-1 and IL-6 the observed differences were not statistically significant between patients with ARDS (IL-1: 34 (65) pg/ml; IL-6: 712 (1058) pg/ml), those with severe pneumonia (IL-1: 3 (4) pg/ml, p = 0.071; IL-6: 834 (1165) pg/ml, p = 1.0), and controls (IL-1: 6 (11) pg/ml, p = 0.359; IL-6: 94 (110) pg/ml, p = 0.262). TNF- (standardised coefficient  = 0.410, p<0.001) and IL-1 (standardised coefficient  = 0.311, p = 0.006) were most strongly associated with the degree of lung injury, even when the diagnostic group was included in the statistical model.
CONCLUSIONSSerum TNF- levels were higher in patients with ARDS than in those with severe pneumonia or in control subjects. Multivariate results suggest that the levels of systemic TNF- and IL-1 reflect the severity of the lung injury rather than the diagnosis.


Keywords: acute respiratory distress syndrome (ARDS); pneumonia; cytokines

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© 2000 by Thorax
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