Valor de las citocinas proinflamatorias como factor de predicción de sepsis y mortalidad en el anciano con fiebre

BACKGROUND AND OBJECTIVE: Proinflammatory cytokines (IL-1β, IL-6, TNF-α) are excellent predictive factors of tissue damage, inflammation and infection. However, there is not sufficient data about their usefulness in elderly patients with acute septic pathology. Our objective was to identify the cytokines related to bacteremia and those that predicted a bad prognosis in elderly patients. PATIENTS AND METHOD: Prospective study carried out during 1999. Patients aged ≥ 60 years with temperature ≥ 38 °C admitted to the emergency ward. We determined IL-1β, IL-6, TNF-α and C-reactive protein (CRP); cultures were done according to the infectious source. On the 4^th day, cytokines and CRP were recorded again. The follow-up was completed until cure or death. RESULTS: 50 patients were included (29 males). Median age was 75.6 (SD: 8.98). The etiology was infectious in 44 (88%): respiratory in 29 (66%), urinary in 8 (18%) and other sources in 7. Thirteen patients had bacteremia (32%): Escherichia coli (4), Streptococcus pneumoniae (5) and others (4). Ten patients died (20%). Median values on admission were CRP: 6.67 mg/dl (NV ≤ 0.8), TNF-α: 29 pg/ml (NV ≤ 0-20), IL-1β: 7 pg/ml (NV ≤ 15) and IL-6: 121 pg/ml (NV ≤ 5). 4^th day values were: 4.23 mg/dl, 22 pg/ml, 1 pg/ml and 41 pg/ml, respectively. The levels of IL-1b in the 2^nd determination were significantly lower in females (p = 0.019). Initial TNF-α (p = 0.033), IL-1β (p = 0.013) and IL-6 (p = 0.031) values were significantly higher in bacteremia patients. IL-6 values on the 4th day were higher in patients who died (p = 0.06). In patients who died, IL-6 levels were higher in the 2nd determination (p = 0.09). CONCLUSIONS: Median values of all cytokines were higher in the bacteremia population. Patients who died showed higher levels of IL-6 on the 4 ^th day.