Intensive Care Medicine

, Volume 31, Issue 10, pp 1415–1419 | Cite as

A predominantly anti-inflammatory cytokine profile is associated with disease severity in meningococcal sepsis

  • Enitan D. Carrol
  • Alistair P. J. Thomson
  • Ashley P. Jones
  • Graham Jeffers
  • C. Anthony Hart
Pediatric Original

Abstract

Objective

This study aimed to determine whether an anti-inflammatory profile in meningococcal disease is associated with an increased risk of severe disease or septic shock.

Design and setting

Prospective observational study in a tertiary care children’s hospital.

Patients and participants

63 children with confirmed meningococcal disease.

Interventions

Plasma concentrations of interleukin-1 receptor antagonist (IL-1Ra), interleukin-6 (IL-6), interleukin-8 (IL-8) and tumour necrosis factor-α (TNF) were assayed on admission. Receiver operator characteristic curve analysis was used to determine optimum thresholds for IL-1Ra:TNF, IL-1Ra:IL-6 and IL-1Ra:IL-8 ratios.

Measurements and results

Median IL-1Ra:TNF and IL-1Ra:IL-6 ratios were significantly higher in severe disease with septic shock than in severe disease without septic shock and in non severe disease (IL-1Ra:TNF 263 vs. 185 vs. 108; IL-1Ra:IL-6 139 vs. 23 vs. 17). Median IL-1Ra:IL-8 ratios were not significantly different in the three groups. A significantly larger proportion of children with high IL-1Ra:TNF-α and IL-1Ra:IL-6 ratios developed severe disease with septic shock than those with a low ratios (95.2% vs. 4.8%; 76.2% vs. 23.8%).

Conclusions

An anti-inflammatory profile appears to be associated with the development of severe disease and septic shock in meningococcal sepsis. This may imply that experimental new therapies of pro-inflammatory cytokine inhibition and anti-inflammatory cytokines in meningococcal disease could be detrimental.

Keywords

Meningococcal disease Cytokine Septic shock Logistic regression 

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Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Enitan D. Carrol
    • 1
    • 2
    • 3
  • Alistair P. J. Thomson
    • 2
    • 3
  • Ashley P. Jones
    • 2
    • 4
  • Graham Jeffers
    • 2
  • C. Anthony Hart
    • 3
  1. 1.Wellcome Trust Research LaboratoriesChichiriMalawi
  2. 2.Institute of Child HealthRLCH NHS Trust, Alder HeyLiverpoolUK
  3. 3.Department of Medical MicrobiologyUniversity of LiverpoolLiverpoolUK
  4. 4.Centre for Medical Statistics and Health Evaluation, School Of Health SciencesUniversity of LiverpoolLiverpoolUK

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