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Cytokines and metabolic patterns in pediatric patients with critical illness.

Briassoulis G, Venkataraman S, Thompson A - Clin. Dev. Immunol. (2010)

Bottom Line: Only oxygen consumption (VO(2)) and carbon dioxide production (VCO(2)) (P < .0001) but none of the cytokines and nutritional markers, were independently associated with a hypometabolic pattern.High IL-10 levels (P = .0000) and low measured REE (P = .0000) were independently associated with mortality (11.7%), which was higher in the hypometabolic compared to other metabolic patterns (P < .005).Our results showed that only VO(2) and VCO(2), but not IL-6 or IL-10, were associated with a hypometabolic pattern which predominated the acute phase of stress, and was associated with increased mortality.

View Article: PubMed Central - PubMed

Affiliation: Division of Pediatric Critical Care Medicine, Children's Hospital of Pittsburgh of UPMC, 3705 Fifth Avenue, Pittsburgh, PA 15213, USA. ggbriass@otenet.gr

ABSTRACT
It is not known if cytokines, which are cell-derived mediators released during the host immune response to stress, affect metabolic response to stress during critical illness. The aim of this prospective study was to determine whether the metabolic response to stress is related to the inflammatory interleukin-6 (IL-6), 10 (IL-10), and other stress mediators' responses and to assess their relationships with different feeding patterns, nutritional markers, the severity of illness as assessed by the Multiple Organ System Failure (MOSF), the Pediatric Risk of Mortality Score (PRISM), systemic inflammatory response syndrome (SIRS), and mortality in critically ill children. Patients were classified as hypermetabolic, normometabolic, and hypometabolic when the measured resting energy expenditures (REE) were >110%, 90-110% and, <90% of the predicted basal metabolic rate, respectively. The initial predominance of the hypometabolic pattern (48.6%) declined within 1 week of acute stress (20%), and the hypermetabolic patterns dominated only after 2 weeks (60%). Only oxygen consumption (VO(2)) and carbon dioxide production (VCO(2)) (P < .0001) but none of the cytokines and nutritional markers, were independently associated with a hypometabolic pattern. REE correlated with the IL-10 but not PRISM. In the presence of SIRS or sepsis, CRP, IL-6, IL-10, Prognostic Inflammatory and Nutritional Index (NI), and triglycerides--but not glucose, VO(2), or VCO(2) increased significantly. High IL-10 levels (P = .0000) and low measured REE (P = .0000) were independently associated with mortality (11.7%), which was higher in the hypometabolic compared to other metabolic patterns (P < .005). Our results showed that only VO(2) and VCO(2), but not IL-6 or IL-10, were associated with a hypometabolic pattern which predominated the acute phase of stress, and was associated with increased mortality. Although in SIRS or sepsis, the cytokine response was reliably reflected by increases in NI and triglycerides, it was different from the metabolic (VO(2), VCO(2)) or glucose response.

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Comparison of metabolic monitor measurements, various cytokines, and nutritional markers between patients with and without sepsis (scale type power: exponent 0.5). Significantly increased (*) in the presence of sepsis: C-Reactive Protein (CRP), Interleukin-6 (IL-6), Interleukin-10 (IL-10), nutritional index, and triglycerides (t-test for unpaired data). Significantly decreased (#) despite a higher protein intake: transferrin and transthyretin. Did not differ compared to the nonsepsis patients: lactate, glucose, fibrinogen, Oxygen Consumption (VO2), and Resting Energy Expenditure (REE). BSA: Body Surface Area.
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fig2: Comparison of metabolic monitor measurements, various cytokines, and nutritional markers between patients with and without sepsis (scale type power: exponent 0.5). Significantly increased (*) in the presence of sepsis: C-Reactive Protein (CRP), Interleukin-6 (IL-6), Interleukin-10 (IL-10), nutritional index, and triglycerides (t-test for unpaired data). Significantly decreased (#) despite a higher protein intake: transferrin and transthyretin. Did not differ compared to the nonsepsis patients: lactate, glucose, fibrinogen, Oxygen Consumption (VO2), and Resting Energy Expenditure (REE). BSA: Body Surface Area.

Mentions: Compared to patients with no SIRS, patients with SIRS had elevated CRP (22 ± 15 mg/dl versus 5 ± 5 mg/dl, P < .0001), IL-6 (1277 ± 1675 versus 140 ± 77 pg/mL, P < .03), IL-10 (116 ± 129 versus 44 ± 18 pg/mL, P < .05), NI (11.2 ± 13 mg/dl versus 2.3 ± 2.4 mg/dl, P < .02), and triglycerides (352 ± 455 mg/dl versus 81 ± 26 mg/dl, P < .01) levels. But, transferrin (100 ± 41 versus 171 ± 33 mg/dl, P < .0001) and transthyretin (10 ± 4 versus 15 ± 6 mg/dl, P < .01) were lower in the presence of SIRS despite a higher protein intake (6 ± 4.5 versus 3.3 ± 3 g/kg/day, P < .005) (Figure 1). Similar results were observed in septic patients (Figure 2). Children with septic shock had had significantly higher levels of IL-6 (2659 ± 2206 versus 475 ± 981 pg/mL, P < .005) and IL-10 (219 ± 246 versus 63 ± 54 pg/mL, P < .007). Stepwise regression analysis (F = 12, P = .0002) showed that NI was positively correlated with SIRS (r2 = .35, P = .007) and IL-6 (r2 = 0.47, P = .01).


Cytokines and metabolic patterns in pediatric patients with critical illness.

Briassoulis G, Venkataraman S, Thompson A - Clin. Dev. Immunol. (2010)

Comparison of metabolic monitor measurements, various cytokines, and nutritional markers between patients with and without sepsis (scale type power: exponent 0.5). Significantly increased (*) in the presence of sepsis: C-Reactive Protein (CRP), Interleukin-6 (IL-6), Interleukin-10 (IL-10), nutritional index, and triglycerides (t-test for unpaired data). Significantly decreased (#) despite a higher protein intake: transferrin and transthyretin. Did not differ compared to the nonsepsis patients: lactate, glucose, fibrinogen, Oxygen Consumption (VO2), and Resting Energy Expenditure (REE). BSA: Body Surface Area.
© Copyright Policy - open-access
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC2871553&req=5

fig2: Comparison of metabolic monitor measurements, various cytokines, and nutritional markers between patients with and without sepsis (scale type power: exponent 0.5). Significantly increased (*) in the presence of sepsis: C-Reactive Protein (CRP), Interleukin-6 (IL-6), Interleukin-10 (IL-10), nutritional index, and triglycerides (t-test for unpaired data). Significantly decreased (#) despite a higher protein intake: transferrin and transthyretin. Did not differ compared to the nonsepsis patients: lactate, glucose, fibrinogen, Oxygen Consumption (VO2), and Resting Energy Expenditure (REE). BSA: Body Surface Area.
Mentions: Compared to patients with no SIRS, patients with SIRS had elevated CRP (22 ± 15 mg/dl versus 5 ± 5 mg/dl, P < .0001), IL-6 (1277 ± 1675 versus 140 ± 77 pg/mL, P < .03), IL-10 (116 ± 129 versus 44 ± 18 pg/mL, P < .05), NI (11.2 ± 13 mg/dl versus 2.3 ± 2.4 mg/dl, P < .02), and triglycerides (352 ± 455 mg/dl versus 81 ± 26 mg/dl, P < .01) levels. But, transferrin (100 ± 41 versus 171 ± 33 mg/dl, P < .0001) and transthyretin (10 ± 4 versus 15 ± 6 mg/dl, P < .01) were lower in the presence of SIRS despite a higher protein intake (6 ± 4.5 versus 3.3 ± 3 g/kg/day, P < .005) (Figure 1). Similar results were observed in septic patients (Figure 2). Children with septic shock had had significantly higher levels of IL-6 (2659 ± 2206 versus 475 ± 981 pg/mL, P < .005) and IL-10 (219 ± 246 versus 63 ± 54 pg/mL, P < .007). Stepwise regression analysis (F = 12, P = .0002) showed that NI was positively correlated with SIRS (r2 = .35, P = .007) and IL-6 (r2 = 0.47, P = .01).

Bottom Line: Only oxygen consumption (VO(2)) and carbon dioxide production (VCO(2)) (P < .0001) but none of the cytokines and nutritional markers, were independently associated with a hypometabolic pattern.High IL-10 levels (P = .0000) and low measured REE (P = .0000) were independently associated with mortality (11.7%), which was higher in the hypometabolic compared to other metabolic patterns (P < .005).Our results showed that only VO(2) and VCO(2), but not IL-6 or IL-10, were associated with a hypometabolic pattern which predominated the acute phase of stress, and was associated with increased mortality.

View Article: PubMed Central - PubMed

Affiliation: Division of Pediatric Critical Care Medicine, Children's Hospital of Pittsburgh of UPMC, 3705 Fifth Avenue, Pittsburgh, PA 15213, USA. ggbriass@otenet.gr

ABSTRACT
It is not known if cytokines, which are cell-derived mediators released during the host immune response to stress, affect metabolic response to stress during critical illness. The aim of this prospective study was to determine whether the metabolic response to stress is related to the inflammatory interleukin-6 (IL-6), 10 (IL-10), and other stress mediators' responses and to assess their relationships with different feeding patterns, nutritional markers, the severity of illness as assessed by the Multiple Organ System Failure (MOSF), the Pediatric Risk of Mortality Score (PRISM), systemic inflammatory response syndrome (SIRS), and mortality in critically ill children. Patients were classified as hypermetabolic, normometabolic, and hypometabolic when the measured resting energy expenditures (REE) were >110%, 90-110% and, <90% of the predicted basal metabolic rate, respectively. The initial predominance of the hypometabolic pattern (48.6%) declined within 1 week of acute stress (20%), and the hypermetabolic patterns dominated only after 2 weeks (60%). Only oxygen consumption (VO(2)) and carbon dioxide production (VCO(2)) (P < .0001) but none of the cytokines and nutritional markers, were independently associated with a hypometabolic pattern. REE correlated with the IL-10 but not PRISM. In the presence of SIRS or sepsis, CRP, IL-6, IL-10, Prognostic Inflammatory and Nutritional Index (NI), and triglycerides--but not glucose, VO(2), or VCO(2) increased significantly. High IL-10 levels (P = .0000) and low measured REE (P = .0000) were independently associated with mortality (11.7%), which was higher in the hypometabolic compared to other metabolic patterns (P < .005). Our results showed that only VO(2) and VCO(2), but not IL-6 or IL-10, were associated with a hypometabolic pattern which predominated the acute phase of stress, and was associated with increased mortality. Although in SIRS or sepsis, the cytokine response was reliably reflected by increases in NI and triglycerides, it was different from the metabolic (VO(2), VCO(2)) or glucose response.

Show MeSH
Related in: MedlinePlus