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Systemic TNF-a production and severity of disease in severe pneumococcal pneumonia

Abstract number: 1733_689

Calbo E., Alsina M., Rodríguez-Carballeira M., Xercavins M., Cuchi E., Garau J., Network The Spanish Pneumococcal Infection Study

Introduction: Tumour necrosis factor alpha (TNF-a) is one of the earliest mediators of the inflammatory response. It induces a second wave of pro and anti-inflammatory cytokines which are mediators of the inflammatory process. The aim of our study was to analyse the correlation between TNF-a and other cytokines plasma concentrations, clinical variables and severity of disease in patients with pneumococcal pneumonia (SPP) at hospital admission.

Material and Methods: Consecutive adults with pneumonia classes III-V of the Pneumonia Severity Index (PSI) developed by the Pneumonia Outcome Research Team and with a confirmed pneumococcal aetiology were included. At admission, demographic characteristics, smoking and alcohol habits, co morbidities (Charlson score), prognosis measured by PSI and APACHE II scores, immunosuppressive conditions, previous or current therapy with statins, use of non steroidal or steroidal anti-inflammatory drugs, and time between pneumonia onset and hospital admission were prospectively recorded.

Vital signs, haematological and biochemical parameters were also assessed. Circulating levels of CRP, serum amyloid A (SAA), C3a, C5a and cytokines TNF-a, IL-1b, IL-6, IL-8, IL-10, IL-1ra were measured. Comparisons were done among patients with TNF-a above and below the median values.

Results: 28 patients with SPP were included; 14 had TNF-a concentrations <20.8 pg/mL and the other half had TNF-a concentrations above this figure. Both groups were homogeneous in terms of of demographics, clinical characteristics, presence of comorbidities, previous use of statins, severity of disease at presentation, radiological involvement and time between pneumonia onset and admission. The group with higher concentrations of TNF-a presented more frequently bacteraemia (64.3% vs 21.4%; p = 0.027), higher axillary temperature (38.4[SD0.4] vs 37.7[SD0.8]; p = 0.046) and higher concentrations of IL-1 (7.8[SD8.5] vs 2.2[SD3]; p = 0.034), IL-6 (4,952[SD6,498] vs 871[SD1,453]; p = 0.037), and IL-1ra (11,029[SD7,669) vs 5,327[SD616]; p = 0.044).

Conclusions: In pneumococcal pneumonia, higher TNF-a levels were associated with the degree of fever and the frequency of bacteraemia; IL-1, IL-6 and IL-1ra increased in parallel with TNF-a levels. No correlation could be established between TNF-a and severity of disease.

Session Details

Date: 31/03/2007
Time: 00:00-00:00
Session name: European Society of Clinical Microbiology and Infectious Diseases
Subject:
Location: ICC, Munich, Germany
Presentation type:
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