ASSOCIATION BETWEEN IL-10 AND MORTALITY IN SEPSIS-INDUCED ARDS

Abstract

SESSION TITLE: Critical Care Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: While we often think of sepsis as a pro-inflammatory state, there are a host of anti-inflammatory cytokines released to try to keep the immune system in check. An under-recognized complication of sepsis is a relatively immunosuppressed state that occurs in survivors as a result of this immune suppression. IL-10 is an important regulatory interleukin that plays a role in sepsis to reduce inflammatory cytokines and suppress immune cell function. Previous studies have indicated that in septic patients, higher IL-10 level are associated with greater disease severity and poorer prognosis. We sought to corroborate these findings in a cohort of patients with sepsis-induced Acute Respiratory Distress Syndrome (ARDS) and to evaluate the effects of High-Dose Intravenous Vitamin C (HDIVC) on IL-10 levels. We hypothesized that vitamin C may work to mitigate the pathophysiology of ARDS in an IL-10 dependent manner. METHODS: IL-10 levels were measured by ELISA in a cohort of 44 patients from the CITRIS-ALI trial, half of whom received High-Dose Intravenous Vitamin C (HDIVC) and half received placebo. IL-10 levels were measured both at baseline and at 48 hours. The cohort was chosen from a subset of the CITRIS-ALI population at our institution with bio-banked plasma specimens. The CITRIS-ALI trial was a multicenter, randomized, double-blinded, placebo-controlled trial evaluating the role of HDIVC on patients with sepsis-induced ARDS. RESULTS: Consistent with previous studies, we found that higher baseline and 48 hour IL-10 levels were associated with increased mortality. Overall, there was not a significant difference in IL-10 levels between the HDIVC and placebo groups. In a subset of the patients with the highest baseline SOFA scores, however, HDIVC was associated with a large decrease in IL-10 levels that did not meet statistical significance. CONCLUSIONS: In patients with sepsis-induced ARDS, IL-10 levels at baseline and at 48 hours were higher in non-survivors compared to survivors. There was no overall difference between IL-10 levels in the placebo and HDIVC arms of the study. The finding of a large decrease in IL-10 in the sickest survivors treated with HDIVC suggests that HDIVC may play a role in modulating the pro- and anti-inflammatory milieu. CLINICAL IMPLICATIONS: This study provides further evidence for the prognostic role of IL-10 in patients with sepsis-induced ARDS. It also provides some insight into a potential mechanism for HDIVC in treating ARDS. DISCLOSURES: No relevant relationships by Bernard Fisher, source=Web Response no disclosure on file for Alpha Fowler; no disclosure on file for Markos Kashiouris; No relevant relationships by Michael L'Heureux, source=Web Response