Sepsis-3 the Dysregulated Host Response and Cytokine Changes
Jaehne AK, Chen Y, Schoenling A, Gill JK, Deledda J, Poisson L, and Rivers EP. Sepsis-3 the dysregulated host response and cytokine changes. Am J Respir Crit Care Med 2017; 195.
Am J Respir Crit Care Med
RATIONALE: New Sepsis-3 definitions have been published, stating that sepsis is a “life-threatening organ dysfunction caused by a dysregulated host response to infection”. The Sepsis-3 authors identified that “Limitations of previous definitions included an excessive focus on inflammation and inadequate specificity and sensitivity of the systemic inflammatory response syndrome (SIRS) criteria.” With the new definitions it was proposed that identification of septic patients with a dysregulated host response is aided by the use of a quick SOFA (qSOFA) score and not by the use of SIRS criteria. qSOFA score is considered abnormal when 2 of 3 criteria are met. These criteria include sytolic blood pressure < 100mmHg, respiratory rate > 24 and mental status changes. We re-examined an established data-base for patients with vasopressor dependent septic shock comparing SIRS criteria to qSOFA criteria in concern to available measured cytokine markers as indicator of a dysregulated host response. If qSOFA indicates an abnormal host response, prominent cytokine markers such as IL-1RA, IL-1α, IL-6, IL-8, IL-10 and TNF-α should show similar trends as SIRS criteria.
METHODS: Re-examination of established IRB approved research data base for patients with vasopressor dependent septic shock with measured multiplex cytokine markers (Milliplex HCYTMAG-60K-PX29) as indicator of a dysregulated host response to infection in concern to SIRS criteria and newly established qSOFA score.
RESULTS: For 174 patients data was re-examined. At the time of enrollment within 24 hours following shock onset the average qSOFA score was 1.47 and average SIRS criteria 2.06. Table 1 shows measured cytokine values in regard to number of either SIRS criteria or qSOFA score. The average values of measured cytokine markers increased with increasing number of SIRS criteria for IL-1RA, IL-1a, IL-6, IL-8, IL-10 and TNF-a. Similar cytokine increases in relation to the number of qSOFA score was only seen for IL-8, IL-10 and TNF-a.∗Average values shown as ng/mL (Table presented).
CONCLUSION. In patients with vasopressor dependent shock increasing SIRS criteria are related to increases in measured circulating cytokine markers of inflammation. Circulating cytokine markers as indicator for an abnormal host response to infection do not increase with increasing qSOFA scores similar to the SIRS criteria and therefore may not be indicative of all aspects of this dysregulated host response.