Criteria of the systemic inflammatory response syndrome
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Abstract
An absence of a unique approach to an assessment of pneumonia severity makes difficult an objective evaluation of a patient’s status. A detection of the disease severity is intended to select patients with the systemic inflammatory response syndrome (SIRS), as long as it is based on dysregulation of the immune response and an excessive production of cytokines. The present work was aimed to show how far clinical and laboratory criteria of SIRS in pneumonia reflect the systemic inflammatory reaction of an organism. Markers of this reaction are cytokines: interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10 (IL-10) and C-reactive protein (CRP). The study group involved severe pneumonia patients. The pneumonia patients fitted to the SIRS criteria (ACCP/SCCM, 1992) were randomly divided into 2 groups according to a severity assessed by the SAPS II scale. The control group (/7=30) formed patients without SIRS. IL-6, IL-8, IL-10 and CRP blood concentrations were measured in both the groups simultaneously with detection of the SIRS signs on the 1st, the 3rd, the 5th, the 7th and the 10th days of the study. The 1st group included the patients (n=22) having the death probability of 7.64% (4.67-10.64) according to the SAPS II scale; the 2nd group patients (/7=26) had the same index of 2.28% (0.81-2.93), p<0.006. The IL-6 concentration in the 1st group was significantly higher than in the 2nd group and the least IL-6 level was in the controls (p<0.006). The total IL-8 value in the 1st group exceeded this parameter in the 2nd and the control groups. But this summary difference between the 1st and the 2nd groups was not statistically reliable (p>0.05). The IL-10 level differed greatly (p<0.0001) between the 1st and the 2nd study groups as well as compared with the control group patients. The severe pneumonia patients (according to the SAPS II scale) demonstrated higher CRP concentration than the 2nd group and the controls (p<0.001). Patients with pneumonia and SIRS signs were found to have high IL-6, IL-8, 11-10 and CRP blood concentrations, meanwhile the pneumonia patients without SIRS show a level of these markers not increased. So, the SIRS criteria characterize the severity of the inflammatory reaction of an organism based on the IL-6, IL-8, IL-10 and CRP levels in pneumonia patients.
About the Authors
V. G. Kukes
Московская медицинская академия им. И.М.Сеченова
Russian Federation
Russian Federation
A. A. Igonin
Московская медицинская академия им. И.М.Сеченова
Russian Federation
Russian Federation
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Review
For citations:
Kukes V.G., Igonin A.A. Criteria of the systemic inflammatory response syndrome. PULMONOLOGIYA. 2003;(4):15-21. (In Russ.)
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ISSN 0869-0189 (Print)
ISSN 2541-9617 (Online)
ISSN 2541-9617 (Online)
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