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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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Related in: MedlinePlus

Only Oxygen consumption (VO2) and carbon dioxide production (VCO2) differed significantly among metabolic patterns (ANOVA, Bonferroni post-hoc tests, P < .0001). None of the cytokines and nutritional markers differed between the metabolic patterns. Note the (nonsignificant) lower trend of the Pediatric Risk of Mortality Score (PRISM) and C-Reactive Protein (CRP) values in the hypermetabolic group of patients. The Box-whisker plots show the median (horizontal line within the box) and the 10th and 90th percentiles (whiskers). The box length is the interquartile range (logarithmic scale). Solid circles represent outliers, stars extremes. IL-6: Interleukin-6, IL-10: Interleukin-10.
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fig5: Only Oxygen consumption (VO2) and carbon dioxide production (VCO2) differed significantly among metabolic patterns (ANOVA, Bonferroni post-hoc tests, P < .0001). None of the cytokines and nutritional markers differed between the metabolic patterns. Note the (nonsignificant) lower trend of the Pediatric Risk of Mortality Score (PRISM) and C-Reactive Protein (CRP) values in the hypermetabolic group of patients. The Box-whisker plots show the median (horizontal line within the box) and the 10th and 90th percentiles (whiskers). The box length is the interquartile range (logarithmic scale). Solid circles represent outliers, stars extremes. IL-6: Interleukin-6, IL-10: Interleukin-10.

Mentions: On the first day of stress, 48.6% of children were hypometabolic, 40.5% normometabolic, and only 10.8% hypermetabolic. In the series of longitudinal measurements of the 37 patients, the predominance of the hypometabolic pattern declined within 1 week of acute stress (20%) and the hypermetabolic pattern only emerged after 2 weeks (60%) (Figure 4). Although there was a trend for lower levels of cytokines and indices of severity of illness among hypermetabolic patients (Figure 5), only VO2 and VCO2 were independently associated with a hypometabolic pattern (P < .0001). There was increased incidence of hypometabolic pattern in patients with MOSF (51.7% versus 37.9%) or septic shock (57.1% versus 35.7%), which however did not reach statistical significance, and increased incidence of hypermetabolic pattern in patients with APEM (33% versus 16.4%, P < .004) or muscle stores depletion (66.7% versus 10%, P < .001). There was no relation between metabolic patterns and disease groups, SIRS, steroids, blocking agents, and gender.


Cytokines and metabolic patterns in pediatric patients with critical illness.

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

Only Oxygen consumption (VO2) and carbon dioxide production (VCO2) differed significantly among metabolic patterns (ANOVA, Bonferroni post-hoc tests, P < .0001). None of the cytokines and nutritional markers differed between the metabolic patterns. Note the (nonsignificant) lower trend of the Pediatric Risk of Mortality Score (PRISM) and C-Reactive Protein (CRP) values in the hypermetabolic group of patients. The Box-whisker plots show the median (horizontal line within the box) and the 10th and 90th percentiles (whiskers). The box length is the interquartile range (logarithmic scale). Solid circles represent outliers, stars extremes. IL-6: Interleukin-6, IL-10: Interleukin-10.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2871553&req=5

fig5: Only Oxygen consumption (VO2) and carbon dioxide production (VCO2) differed significantly among metabolic patterns (ANOVA, Bonferroni post-hoc tests, P < .0001). None of the cytokines and nutritional markers differed between the metabolic patterns. Note the (nonsignificant) lower trend of the Pediatric Risk of Mortality Score (PRISM) and C-Reactive Protein (CRP) values in the hypermetabolic group of patients. The Box-whisker plots show the median (horizontal line within the box) and the 10th and 90th percentiles (whiskers). The box length is the interquartile range (logarithmic scale). Solid circles represent outliers, stars extremes. IL-6: Interleukin-6, IL-10: Interleukin-10.
Mentions: On the first day of stress, 48.6% of children were hypometabolic, 40.5% normometabolic, and only 10.8% hypermetabolic. In the series of longitudinal measurements of the 37 patients, the predominance of the hypometabolic pattern declined within 1 week of acute stress (20%) and the hypermetabolic pattern only emerged after 2 weeks (60%) (Figure 4). Although there was a trend for lower levels of cytokines and indices of severity of illness among hypermetabolic patients (Figure 5), only VO2 and VCO2 were independently associated with a hypometabolic pattern (P < .0001). There was increased incidence of hypometabolic pattern in patients with MOSF (51.7% versus 37.9%) or septic shock (57.1% versus 35.7%), which however did not reach statistical significance, and increased incidence of hypermetabolic pattern in patients with APEM (33% versus 16.4%, P < .004) or muscle stores depletion (66.7% versus 10%, P < .001). There was no relation between metabolic patterns and disease groups, SIRS, steroids, blocking agents, and gender.

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