Daily variation in circulating cytokines and acute‐phase proteins correlates with clinical and laboratory indices in community‐acquired pneumonia

Abstract

Our objective was to investigate the initial levels of circulating proinflammatory cytokines, such as interleukin 1 beta (IL-1 beta), interleukin 6 (IL-6), and tumour necrosis factor alpha (TNF-alpha), of certain acute-phase proteins, such as C-reactive protein (CRP), fibrinogen (FBN) and albumin, and of the glycoprotein fibronectin at presentation and their daily variation during the clinical course of community-acquired pneumonia (CAP) in relation to clinical and laboratory indices of infection. Thirty otherwise healthy hospitalized patients aged 48 +/- 3 years (mean +/- SEM) and with bacteriologically confirmed CAP were studied prospectively. IL-1 beta and IL-6 were found to be 15-fold higher on admission (122 +/- 9 pg mL-1 and 60 +/- 4 pg mL-1 respectively), whereas TNF-alpha was three-fold higher (102 +/- 5 pg mL-1) than those of controls, all of them showing a decline towards normal. Initial CRP levels were increased 90-fold (416 +/- 1 mg L-1), whereas fibronectin levels were reduced (242 +/- 9 mg dL-1). The presence of parapneumonic effusion was associated with a higher TNF-alpha serum level (127 +/- 7 vs. 86 +/- 4 pg mL-1, P = 0.0002), a more rapid daily decline in TNF-alpha (-7.2 +/- 0.7 vs. -3.8 +/- 0.5 pg mL-1 day-1, P = 0.0005), a slower rate of decline in CRP (-42.8 +/- 3.0 vs. -54.6 +/- 3.0 mg L-1 day-1, P = 0.02) and a slower rate of increase in FBN (5.9 +/- 1.0 vs. 11.7 +/- 1.0 mg dL-1 day-1), P = 0.001]. Furthermore, daily progression of serum levels of cytokines and acute-phase proteins correlated strongly with pyrexia, erythrocyte sedimentation rate (ESR), neutrophil count, alveolar-arterial oxygen difference and radiographic resolution, clinically manifested by improvement in the patients' condition.

Systemic Expression of Cytokine Production in Patients with Severe Pneumococcal Pneumonia: Effects of Treatment with a β-Lactam versus a Fluoroquinolone

“…In our study, sequential determinations showed a pattern of decline, with progressive normalization of all proand anti-inflammatory cytokines detected, which was accompanied by clinical recovery. In the mouse model of pneumococcal pneumonia (5,12), this response is a process involving 4 (25) 4 (25) on May 11, 2018 by guest http://aac.asm.org/ (2,9,14,17,22,28,32,33). In general, the differing results reported would support the short half-life or the rapid local clearance (16) as the causes of the absence of detectable levels of IL-1␤ in the systemic circulation.…”

“…Many recent trials have analyzed the relationship between the intensity of the systemic cytokine production over time and the severity of the community-acquired pneumonia (2,17,25,28). A direct relationship between the intensity of the inflammatory response and the severity of the episode has been well established.…”

“…Many studies have analyzed cytokine concentrations either at a single time point (14,21,29,37) or over time (2,9,17,22,25,28,(31)(32)(33)(34) in pneumonia. These studies included a heterogeneous population with different etiologies, severity of dis-ease, comorbidities, and treatment.…”

Inflammatory Responses in Blood Samples of Human Immunodeficiency Virus-Infected Patients with Pulmonary Infections

“…An increase in proinflammatory cytokines, such as IL-1␤, IL-6, and TNF-␣, as well as acute-phase proteins, such as CRP, has been described in BP (20,27). IL-8 seems to be another inflammation-associated cytokine.…”

“…The local and systemic inflammatory response in BP, with special emphasis on the patterns of cytokines and levels of CRP, has been studied in recent years in the immunocompetent population (20,22,23,27). An increase in proinflammatory cytokines, such as IL-1␤, IL-6, and TNF-␣, as well as acute-phase proteins, such as CRP, has been described in BP (20,27).…”