0

The full content of Annals is available to subscribers

Subscribe/Learn More  >
Articles |

The Association between Mortality Rates and Decreased Concentrations of Interleukin-10 and Interleukin-1 Receptor Antagonist in the Lung Fluids of Patients with the Adult Respiratory Distress Syndrome

Seamas C. Donnelly, MD; Robert M. Strieter, MD; Peter T. Reid, MRCP; Steven L. Kunkel, PhD; Marie D. Burdick, BSc; Ian Armstrong, FRCA; Alasdair Mackenzie, FRCA; and Christopher Haslett, FRCP
[+] Article and Author Information

From the University of Edinburgh, the Royal Infirmary, and Western General Hospitals, Edinburgh, United Kingdom, and University of Michigan, Ann Arbor, Michigan. Acknowledgments: The authors thank the staff of the intensive therapy units at the Royal Infirmary and Western General Hospitals, Edinburgh, United Kingdom, for their help and cooperation. Grant Support: In part by the British Lung Foundation and Chest, Heart, and Stroke Scotland. Requests for Reprints: Christopher Haslett, FRCP, Rayne Laboratory, University Medical School, Teviot Place, Edinburgh, EH8 9AG, Scotland. Current Author Addresses: Drs. Donnelly and Reid and Professor Haslett: Respiratory Medicine Unit, University of Edinburgh, Edinburgh, Scotland.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1996;125(3):191-196. doi:10.7326/0003-4819-125-3-199608010-00005
Text Size: A A A

Objectives: To determine the relation between 1) intraalveolar concentrations of the proinflammatory cytokines (tumor necrosis factor, interleukin-1 β, and interleukin-8) and the anti-inflammatory cytokines (interleukin-10 and interleukin-1 receptor antagonist) in patients with early adult respiratory distress syndrome [ARDS] and 2) subsequent patient mortality rates.

Design: Prospective cohort study.

Setting: University medical center.

Patients: 28 consecutive patients in whom ARDS was prospectively identified during hospitalization and 9 ventilated controls.

Measurements: Concentrations of proinflammatory cytokines and anti-inflammatory cytokines in bronchoalveolar lavage fluid.

Results: The concentrations of proinflammatory and anti-inflammatory cytokines within the alveolar air spaces were significantly elevated in patients with ARDS compared with controls (P = 0.01 for tumor necrosis factor [median, 90 pg/mL (range, 0 to 2500 pg/mL) for patients with ARDS; median, 0 pg/mL (range, 0 to 118 pg/mL) for controls]; P = 0.001 for interleukin-1 β [median, 179 pg/mL (range, 0 to 2200 pg/mL) for patients with ARDS; median, 0 pg/mL (range, 0 to 80 pg/mL) for controls]; P = 0.0001 for interleukin-8 [median, 628 pg/mL (range, 0 to 4700 pg/mL) for patients with ARDS; median, 0 pg/mL (range, 0 to 278 pg/mL) for controls]; P = 0.0005 for interleukin-10 [median, 100 pg/mL (range, 0 to 1600 pg/mL) for patients with ARDS; median, 0 pg/mL (range, 0 to 50 pg/mL) for controls], and P = 0.002 for interleukin-1 receptor antagonist [median, 820 pg/mL (range, 0 to 18 900 pg/mL) for patients with ARDS; median, 50 pg/mL (range, 0 to 240 pg/mL) for controls]). A highly significant correlation was found between low concentrations of anti-inflammatory cytokines and subsequent patient mortality rates (P = 0.003 for interleukin-10 [median, 120 pg/mL (range, 30 to 1600 pg/mL) for survivors; median, 40 pg/mL (range, 0 to 110 pg/mL) for nonsurvivors]; P = 0.008 for interleukin-1 receptor antagonist [median, 1600 pg/mL (range, 80 to 18 900 pg/mL) for survivors; median, 90 pg/mL (range, 0 to 3400 pg/mL) for nonsurvivors. No significant correlation was found between the concentrations of the proinflammatory cytokines and mortality rates.

Conclusion: Low concentrations of the anti-inflammatory cytokines interleukin-10 and interleukin-1 receptor antagonist in bronchoalveolar lavage fluid obtained from patients with early ARDS are closely associated with poor prognosis. These findings support the hypothesis that failure to mount a localized intrapulmonary anti-inflammatory response early in the pathogenesis of ARDS contributes to more severe organ injury and worse prognosis. Our findings suggest that augmenting anti-inflammatory cytokine defenses would be a beneficial therapeutic approach to patients with ARDS and other inflammatory diseases.

Figures

Grahic Jump Location
Figure 1.
Concentrations of interleukin-10 in bronchoalveolar lavage samples obtained from ventilated controls (n = 9), survivors of the adult respiratory distress syndrome (ARDS) (n = 18), and nonsurvivors of ARDS (n = 10).
Grahic Jump Location
Grahic Jump Location
Figure 2.
Concentrations of interleukin-1 receptor antagonist in bronchoalveolar lavage samples obtained from ventilated controls (n = 9), survivors of the adult respiratory distress syndrome (ARDS) (n = 18), and nonsurvivors of ARDS (n = 10).
Grahic Jump Location

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
Submit a Comment

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Advertisement
Related Articles
Related Point of Care
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)