Serial estimation of cytokine markers and their correlation with mortality in elderly patients with sepsis

Introduction

Sepsis is a serious health problem in the elderly with a high degree of mortality. The study of pathophysiology of sepsis has lead to the development of cytokine markers which help in establishing diagnosis, quantifying the severity and assessing the response to therapy. TNFα and IL-6, a pleotropic cytokine, are among the most well-studied proinflammatory cytokines in sepsis. However, very limited data are available in elderly subjects regarding the markers for sepsis. The present study was undertaken to establish the cytokine profile in sepsis in the elderly and develop markers for prediction. The influence of gender on cytokine production and mortality in elderly patients with sepsis was considered in particular.

Methods

In this prospective study, 50 elderly patients, age above 65 years, satisfying the systemic inflammatory response syndrome (SIRS) criteria were included. Serial estimations of TNFα and IL-6 were done on days 1, 3 and 7 of ICU admission.

Results

The results were drawn on the basis of gender and survival. A correlation of APACHE score, TNFα values and IL-6 values on day 1, day 3 and day 7 between survivors and nonsurvivors was also documented, which showed reducing levels of IL-6 levels from days 1 to 7 in the survivor group (P < 0.01). The TNFα level was significantly low on day 1 in the nonsurvivor female group (P < 0.00001).

Conclusions

Cytokine profiling for TNFαand IL-6 level in elderly patients with sepsis helps in prognosticating the outcome. Female gender was an independent predictor of increased morality in critically ill patients with documented infection.