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a Servei de
Pneumologia I Al.lèrgia Respiratoria, Hospital Clinic, Universitat de
Barcelona, Barcelona, Spain, b Servei de Bioquímica, c Area de Vigilancia Intensiva, d UCI
Quirúrgica
Correspondence to: Dr A Torres, Hospital Clinic I Provincial, Servei de Pneumologia I Al.lèrgia Respiratoria, Villarroel 170, E-08036 Barcelona, Spain
Received 5 March 1999; Returned to authors 11 June 1999; Revised version received 28 July 1999; Accepted for publication 7 September 1999
BACKGROUND
The
inflammatory response has been widely investigated in patients with
acute respiratory distress syndrome (ARDS) and pneumonia. Studies
investigating the diagnostic values of serum cytokine levels have
yielded conflicting results and only little information is available
for the differential diagnosis between ARDS and pneumonia.
METHODSClinical and
physiological data, serum concentrations of tumour necrosis factor
(TNF)-
, interleukin (IL)-1
and IL-6, and quantitative cultures of
lower respiratory tract specimens were obtained from 46 patients with
ARDS and 20 with severe pneumonia within 24 hours of the onset of the
disease and from 10 control subjects with no inflammatory lung disease.
Cytokine concentrations were compared between groups and determinants
in addition to the diagnosis were tested.
RESULTSSerum TNF-
levels were significantly higher in ARDS patients (67 (57) pg/ml) than
in patients with severe pneumonia (35 (20) pg/ml; p = 0.031) or
controls (17 (8) pg/ml; p = 0.007). For IL-1 and IL-6 the observed
differences were not statistically significant between patients with
ARDS (IL-1: 34 (65) pg/ml; IL-6: 712 (1058) pg/ml), those with
severe pneumonia (IL-1: 3 (4) pg/ml, p = 0.071; IL-6: 834 (1165) pg/ml, p = 1.0), and controls (IL-1: 6 (11) pg/ml, p = 0.359; IL-6: 94 (110) pg/ml, p = 0.262). TNF- (standardised coefficient = 0.410, p<0.001) and IL-1 (standardised
coefficient = 0.311, p = 0.006) were most strongly associated with
the degree of lung injury, even when the diagnostic group was included
in the statistical model.
CONCLUSIONSSerum
TNF- levels were higher in patients with ARDS than in those with
severe pneumonia or in control subjects. Multivariate results suggest
that the levels of systemic TNF- and IL-1 reflect the severity of
the lung injury rather than the diagnosis.
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