Factors associated with inflammatory cytokine patterns in community-acquired pneumonia

Abstract

Raised systemic levels of interleukin (IL)-6 and IL-10 cytokines have been associated with poorer outcome in community-acquired pneumonia. The aim of our study was to identify potential associated factors with increased levels of IL-6, IL-10, or both cytokines.We performed a prospective study of 685 patients admitted to hospital with communityacquired pneumonia. IL-6 and IL-10 were measured in blood in the first 24 h.30-day mortality increased from 4.8% to 11.4% (p50.003) when both cytokines were higher than the median. Independent associated factors with an excess of IL-6 were neurologic disease, confusion, serum sodium ,130 mEq?L -1 , pleural effusion, and bacteraemia. The associated factors for an excess of IL-10 were respiratory rate o30 breaths?min -1, systolic blood pressure ,90 mmHg and glycaemia o250 mg?dL -1 . The independent associated factors for an excess of both cytokines were confusion, systolic blood pressure ,90 mmHg, pleural effusion and bacteraemia. Protective factors were prior antibiotic treatment and pneumococcal vaccination.Different independent factors are related to an excess of IL-6 and IL-10. Confusion, hypotension, pleural effusion and bacteraemia were associated with the inflammatory profile with the highest mortality rate, whereas anti-pneumococcal vaccination and previous antibiotic treatment appeared to be protective factors.

Severity and outcomes of hospitalised community-acquired pneumonia in COPD patients

“…Previous treatment with ICS failed to be an independent protective factor against mortality, but it was a protective factor against the development of respiratory complications at admission and during hospitalisation. Thus, we cannot discard the possibility that previous administration of ICS is not only a ''marker of COPD'', but that it may reduce lung inflammatory response resulting in fewer pulmonary complications [22]. In concordance with this hypothesis, different authors have clearly suggested that ICS could diminish CAP severity by modulating the local inflammatory response (lung microenvironment and macrophage activation) [23] and subsequent organ dysfunction [24,25] and, possibly, could even reduce mortality rate [26,27].…”

Guidelines for the diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) in critically ill patients (Part II): Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM) 2017

“…Five additional studies are ongoing. Twelve trials suggested a mortality reduction with corticosteroids, most pronounced in patients with severe rather than mild pneumonia, with some imprecision in the results (relative risk (RR) 0.67, 95% CI 0.45-1.01) [2]. The quality of evidence across outcomes was moderate.…”

“…Lower respiratory infections, the most deadly communicable disease [1], may be characterized by persistent systemic inflammation [2]. Thirteen trials (n = 2005) have investigated varying daily doses (80-400 mg of hydrocortisone-equivalent; i.v.…”

Inhaled corticosteroids and the increased risk of pneumonia: what’s new? A 2015 updated review

“…Also, in a 2014 observational study, previous use of ICS in patients hospitalized for CAP was associated with a reduced systemic inflammatory response, as evidenced by lower interleukin (IL)-6 and tumor necrosis factor (TNF)-α levels [Ferrer et al 2014]. Reduction of the pro-inflammatory response in pneumonia could thus lead to less subsequent organ dysfunction and, therefore, better clinical outcomes [Martinez et al 2011]. Against this hypothesis, however, a 2011 observational study on the impact of ICS on pneumonia outcomes in patients with COPD found no significant difference in the levels of markers of systemic inflammation such as C-reactive protein and white cell count [Singanayagam et al 2011].…”