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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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(a) Only the respiratory quotient (RQ) varied at higher levels in the overfeeding compared to the other groups (ANOVA, Bonferroni post-hoc tests, P < .0001); (b) Nutritional and stress indices did not differ among feeding groups during the acute phase of stress. 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. REE: Resting Energy Expenditure, VO2: Oxygen Consumption, VCO2: Carbon Dioxide production, BSA: Body Surface Area, IL-6: Interleukin-6, IL-10: Interleukin-10.
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fig8: (a) Only the respiratory quotient (RQ) varied at higher levels in the overfeeding compared to the other groups (ANOVA, Bonferroni post-hoc tests, P < .0001); (b) Nutritional and stress indices did not differ among feeding groups during the acute phase of stress. 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. REE: Resting Energy Expenditure, VO2: Oxygen Consumption, VCO2: Carbon Dioxide production, BSA: Body Surface Area, IL-6: Interleukin-6, IL-10: Interleukin-10.

Mentions: Malnourishment (APEM or CPEM), protein depletion (MMA score 2), and fat depletion (MFA score 2) did not affect NI values, IL-6 and IL-10 levels. Neither cytokines nor the NI differed among feeding groups (Figure 8), although RQ varied at higher levels in the overfeeding (0.91) compared to the other groups (.88 and  .89, resp., P < .0001). However, REE, VCO2/BSA, or VO2/BSA did not differ among feeding groups. REE was only correlated with the IL-10 (r2 = −.48, P = .01) and white blood cell count (r2 = .36, P = .001), but not PRISM. The NI was highly increased in the TPN group (11.8 ± 14) compared to either enteral nutrition alone (1.8 ± 2.19) or to various dextrose solution regimens (4.46 ± 5.34) (F = 2.86, P < .07).


Cytokines and metabolic patterns in pediatric patients with critical illness.

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

(a) Only the respiratory quotient (RQ) varied at higher levels in the overfeeding compared to the other groups (ANOVA, Bonferroni post-hoc tests, P < .0001); (b) Nutritional and stress indices did not differ among feeding groups during the acute phase of stress. 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. REE: Resting Energy Expenditure, VO2: Oxygen Consumption, VCO2: Carbon Dioxide production, BSA: Body Surface Area, 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

fig8: (a) Only the respiratory quotient (RQ) varied at higher levels in the overfeeding compared to the other groups (ANOVA, Bonferroni post-hoc tests, P < .0001); (b) Nutritional and stress indices did not differ among feeding groups during the acute phase of stress. 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. REE: Resting Energy Expenditure, VO2: Oxygen Consumption, VCO2: Carbon Dioxide production, BSA: Body Surface Area, IL-6: Interleukin-6, IL-10: Interleukin-10.
Mentions: Malnourishment (APEM or CPEM), protein depletion (MMA score 2), and fat depletion (MFA score 2) did not affect NI values, IL-6 and IL-10 levels. Neither cytokines nor the NI differed among feeding groups (Figure 8), although RQ varied at higher levels in the overfeeding (0.91) compared to the other groups (.88 and  .89, resp., P < .0001). However, REE, VCO2/BSA, or VO2/BSA did not differ among feeding groups. REE was only correlated with the IL-10 (r2 = −.48, P = .01) and white blood cell count (r2 = .36, P = .001), but not PRISM. The NI was highly increased in the TPN group (11.8 ± 14) compared to either enteral nutrition alone (1.8 ± 2.19) or to various dextrose solution regimens (4.46 ± 5.34) (F = 2.86, P < .07).

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