Abstract
Early assessment of necrotising soft tissue infection (NSTI) is challenging. Analysis of inflammatory markers could provide important information about disease severity and guide decision making. For this purpose, we investigated the association between cytokine levels and the Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC)-score, disease severity and mortality in NSTI patients. In 159 patients, plasma was analysed for IL-1β, IL-6, IL-10 and TNF-α upon admission. The severity of NSTI was assessed by SAPS, SOFA score, septic shock, microbial aetiology, renal replacement therapy and amputation. We found no significant difference in cytokine levels according to a LRINEC- score above or below 6 (IL-1β: 3.0 vs. 1.3; IL-6: 607 vs. 289; IL-10: 38.4 vs. 38.8; TNF-α: 15.1 vs. 7.8 pg/mL, P > 0.05). Patients with β-haemolytic streptococcal infection had higher level of particularly IL-6. There was no difference in mortality between patients with a LRINEC-score above or below 6. In the adjusted analysis assessing 30-day mortality, the association was strongest for IL-1β (OR 3.86 [95% CI, 1.43-10.40], P = 0.008) and IL-10 (4.80 [1.67-13.78], P = 0.004). In conclusion, we found no significant association between the LRINEC-score and cytokine levels on admission. IL-6 was consistently associated with disease severity, whereas IL-1β had the strongest association with 30-day mortality.
Highlights
Elevated in patients with sepsis not surviving on Day 28 compared with the levels in survivors[8]
C-reactive protein (CRP) is one of the 6 variables included in the Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC) score and has been found elevated in non-surviving patients with NSTI14
The 43 non-infected control patients (61% men) had a median age of 63 years (IQR, 45–71), CRP of 3 mg/L (IQR, 1–5) and a leucocyte count of 7.1 109/L (IQR, 6.3–9.8). They experienced a significant increase in IL-6 and IL-10 levels after surgery compared with samples taken before surgery, whereas the levels of IL-1βand TNF-αwere not significantly altered by surgery (Fig. 4). In this prospective study of patients with Necrotising soft tissue infection (NSTI), we found that baseline cytokine levels were not significantly different in patients with a LRINEC score ≥6 compared with a score
Summary
Elevated in patients with sepsis not surviving on Day 28 compared with the levels in survivors[8]. Other studies have been unable to find clear associations between the LRINEC score and clinically important outcomes[15,16,17]. C-reactive protein (CRP) is one of the 6 variables included in the LRINEC score and has been found elevated in non-surviving patients with NSTI14. We aimed to investigate the association between plasma levels of inflammatory cytokines and disease severity in patients with NSTI. We focused on the association between IL-1β, IL-6, IL-10 and TNF-αlevel and the simplified acute physiology score II (SAPS II) and Sepsis-related organ failure assessment (SOFA) score, septic shock, β-haemolytic streptococcal infection, renal replacement therapy (RRT), amputation and 30-day mortality
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