This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

Wolfgang Ertel, MD; Florence A. Scholl, PhD; Harald Gallati, PhD; Mario Bonaccio, MD; Friedrich-Wilhelm Schildberg, MD; Otmar Trentz, MD

Arch Surg. 1994;129(12):1330-1337.

Abstract
Objectives
To examine the kinetics of altered soluble tumor necrosis factor receptors (sTNFRs) released in patients with severe sepsis, their correlation with the morbidity and mortality of these patients, and the role of endotoxin to induce cleavage of sTNFRs.

Design
Soluble TNFR levels in plasma obtained from 40 patients with severe sepsis (mean [±SD] Acute Physiology and Chronic Health Evaluation [APACHE] II score, 27.9±7.0 points) on days 0, 1, 3, 5, and 10 after sepsis diagnosis were measured using specific enzyme-linked immunological binding assays and compared with levels in 75 control patients without infection. In addition, an ex vivo model consisting of lipopolysaccharide stimulation of human whole blood as a relevant physiological milieu was used. Blood from patients with sepsis and control patients was incubated in the presence or absence of lipopolysaccharide (1 mg/L) for 0, 1, 2, 4, 8, and 24 hours. Plasma levels of sTNFRs from both groups were determined using the enzyme-linked immunological binding assays.

Results
In patients with sepsis, plasma levels of both sTNFRs were markedly (P<.01) increased during the whole observation period, compared with those of control patients, and correlated (P<.001) with the simultaneously obtained APACHE II and multiple organ failure scores, as well as with mortality. Although incubation of whole blood with lipopolysaccharide increased the release of sTNFR p55 and p75 in both groups, sTNFR concentrations in blood from control patients remained low compared with those of patients with severe sepsis, despite stimulation of whole blood with a maximum lipopolysaccharide concentration.

Conclusions
These data indicate that an enhanced release of sTNFRs during severe sepsis is not solely induced by endotoxin. Since the degree of increased sTNFR levels portended poorly for patient survival, elevated sTNFR levels may represent a good marker for severity of sepsis, thus predicting outcome.

(Arch Surg. 1994;129:1330-1337)

Author Affiliations
From the Division of Trauma Surgery, Department of Surgery, University of Zurich, Switzerland (Drs Ertel, Scholl, Bonaccio, and Trentz); F. Hoffmann—La Roche Ltd, Pharmaceutical Research—New Technologies, Basel, Switzerland (Dr Gallati); and the Department of Surgery, University Hospital Grosshadern, Ludwig--Maximilians University, Munich, Germany (Dr Schildberg).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Glutamine decreases lipopolysaccharide-induced intestinal inflammation in infant rats
Li et al.
Am. J. Physiol. Gastrointest. Liver Physiol. 2004;286:G914-G921.
ABSTRACT | FULL TEXT  

Leucocyte response and anti-inflammatory cytokines in community acquired pneumonia
Kolling et al.
Thorax 2001;56:121-125.
ABSTRACT | FULL TEXT  

Anti-Inflammatory Cytokines
Opal and DePalo
Chest 2000;117:1162-1172.
ABSTRACT | FULL TEXT  

Levels of Inhibitors of Tumor Necrosis Factor Alpha and Interleukin 1beta in Urine and Sera of Patients with Urosepsis
Olszyna et al.
Infect. Immun. 1998;66:3527-3534.
ABSTRACT | FULL TEXT  

Tumor necrosis factor in the heart
Meldrum
Am. J. Physiol. Regul. Integr. Comp. Physiol. 1998;274:R577-R595.
ABSTRACT | FULL TEXT  

Monocyte Tumor Necrosis Factor Receptor Levels as a Predictor of Risk in Human Sepsis
Calvano et al.
Arch Surg 1996;131:434-437.
ABSTRACT