Interleukin-6 and Nitric Oxide Levels in Neonatal Sepsis
Aim: The objectives of this study were to compare interleukin-6 (IL-6) and nitric oxide (NO) levels in newborns with culture-proven sepsis with levels in age- and gestational age (GA)-matched controls, and to investigate the correlation between mediator levels and circulatory functions in the septic group. Materials and Methods: Samples for IL-6 and NO levels were obtained from newborns with blood culture-proven sepsis before the beginning of antibiotic therapy and on the 3rd day of treatment. Heart rate, blood pressure and other treatment modalities including inotropic support were also recorded. Age- and GA-matched newborns without infection were included as controls. Minitab 13.0 was used for statistical analysis. Results: Eighteen septic and 23 control patients were included in the study. IL-6 and NO levels were significantly higher in septic patients, and low blood pressure as a sign of the circulatory effects of sepsis was found to be negatively correlated with IL-6 levels on the 3rd day of treatment in newborns with septic shock. No correlation was found between clinical findings and NO levels. Conclusions: IL-6 and NO levels were high in septic newborns as expected; however, circulatory findings were only correlated with IL-6 levels on the 3rd day of treatment in the septic shock group, suggesting that systemic inflammatory response syndrome (SIRS) is an ongoing process during infection in this subgroup. NO probably plays its major role much earlier as a defense mechanism in the complex chain of events during SIRS.
Interleukin-6 and Nitric Oxide Levels in Neonatal Sepsis
Aim: The objectives of this study were to compare interleukin-6 (IL-6) and nitric oxide (NO) levels in newborns with culture-proven sepsis with levels in age- and gestational age (GA)-matched controls, and to investigate the correlation between mediator levels and circulatory functions in the septic group. Materials and Methods: Samples for IL-6 and NO levels were obtained from newborns with blood culture-proven sepsis before the beginning of antibiotic therapy and on the 3rd day of treatment. Heart rate, blood pressure and other treatment modalities including inotropic support were also recorded. Age- and GA-matched newborns without infection were included as controls. Minitab 13.0 was used for statistical analysis. Results: Eighteen septic and 23 control patients were included in the study. IL-6 and NO levels were significantly higher in septic patients, and low blood pressure as a sign of the circulatory effects of sepsis was found to be negatively correlated with IL-6 levels on the 3rd day of treatment in newborns with septic shock. No correlation was found between clinical findings and NO levels. Conclusions: IL-6 and NO levels were high in septic newborns as expected; however, circulatory findings were only correlated with IL-6 levels on the 3rd day of treatment in the septic shock group, suggesting that systemic inflammatory response syndrome (SIRS) is an ongoing process during infection in this subgroup. NO probably plays its major role much earlier as a defense mechanism in the complex chain of events during SIRS.
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- 1. Goldstein B, Giroir B, Randolph A; International Consensus Conference on Pediatric Sepsis. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med 2005; 6: 2-8.
- 2. Bochud PY, Calandra T. Pathogenesis of sepsis: new concepts and implications for future treatment. BMJ 2003; 326: 262-266.
- 3. Hack CE, De Groot ER, Felt-Bersma RJ, Nuijens JH, Strack Van Schijndel RJ, Eerenberg-Belmer AJ et al. Increased plasma levels of interleukin-6 in sepsis. Blood 1989; 74: 1704-1710.
- 4. Küster H, Weiss M, Willeitner AE, Detlefsen S, Jeremias I, Zbojan J et al. Interleukin-1 receptor antagonist and interleukin-6 for early diagnosis of neonatal sepsis 2 days before clinical manifestation. Lancet 1998; 352: 1271-1277.
- 5. Pathan N, Hemingway CA, Alizadeh AA, Stephens AC, Boldrick JC, Oragui EE et al. Role of interleukin 6 in myocardial dysfunction of meningococcal septic shock. Lancet 2004; 363: 203-209.
- 6. Symeonides S, Balk RA. Nitric oxide in the pathogenesis of sepsis. Infect Dis Clin North Am 1999; 13: 449-463.
- 7. Cobb JP, Danner RL. Nitric oxide and septic shock. JAMA. 1996; 275: 1192-1196.
- 8. Jean-Baptiste E. Cellular mechanisms in sepsis. J Intensive Care Med 2007; 22: 63-72.
- 9. Shi Y, Li HQ, Shen CK, Wang JH, Qin SW, Liu R et al. Plasma nitric oxide levels in newborn infants with sepsis. J Pediatr 1993; 123: 435-438.
- 10. Wong HR, Carcillo JA, Burckart G, Shah N, Janosky JE. Increased serum nitrite and nitrate concentrations in children with the sepsis syndrome. Crit Care Med 1995; 23: 835-842.
- 11. Levy RM, Prince JM, Billiar TR. Nitric oxide: a clinical primer. Crit Care Med 2005; 33: S492-495.
- 12. Doughty LA, Kaplan SS, Carcillo JA. Inflammatory cytokine and nitric oxide responses in pediatric sepsis and organ failure. Crit Care Med 1996; 24: 1137-1143.
- 13. Brahman RS, Hendrix SA. Nanogram nitrite and nitrate determination in environmental and biological materials by vanadium (III) reduction with chemiluminescence detection. Anal Chem 1989; 61: 2715-2718.
- 14. Meisner M. Biomarkers of sepsis: clinically useful? Curr Opin Crit Care. 2005; 11: 473-480.
- 15. Ng PC. Diagnostic markers of infection in neonates. Arch Dis Child Fetal Neonatal Ed 2004; 89: 229-235.
- 16. Romagnoli C, Frezza S, Cingolani A, De Luca A, Puopolo M, Carolis M et al. Plasma levels of interleukin-6 and interleukin-10 in preterm neonates evaluated for sepsis. Eur J Pediatr 2001; 160: 345-350.
- 17. Oberbeck R, Schmitz D, Wilsenack K, Schuler M, Husain B, Schedlowski M et al. Dopamine affects cellular immune functions during polymicrobial sepsis. Int