Criteria of the systemic inflammatory response syndrome

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 1^st, the 3^rd, the 5^th, the 7^th and the 10^th days of the study. The 1^st group included the patients (n=22) having the death probability of 7.64% (4.67-10.64) according to the SAPS II scale; the 2^nd group patients (/7=26) had the same index of 2.28% (0.81-2.93), p<0.006. The IL-6 concentration in the 1^st group was significantly higher than in the 2^nd group and the least IL-6 level was in the controls (p<0.006). The total IL-8 value in the 1^st group exceeded this parameter in the 2^nd and the control groups. But this summary difference between the 1^st and the 2^nd groups was not statistically reliable (p>0.05). The IL-10 level differed greatly (p<0.0001) between the 1^st and the 2^nd 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 2^nd 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.