Comparison Of Pro-inflammatory And Anti-inflammatory Cytokine Levels In Patients With ALI/ARDS

Background:The acute lung injury/acute respiratory distresssyndrome(ALI/ARDS) involves an intense inflammatory response in the lungs, with accumulation of both pro-inflammatory andanti-inflammatory cytokines in plasma. TNF- a and IL-lPhave been propopsed to play a central role in excessive inflammatory response. IL-10 has been identified as an important regulator of this response. Our goal was to determine how the proinflammatory and anti-inflammatory cytokine levels changein plasma before and after the onset of ALI/ARDS;the relation between the cytokines and patient outcome.Patients and Methods: We prospectively studied 28 from groups at risk for ALI/ARDS within 24h of ICU admission, 12 of them developed ALI/ARDS. Using sandwich enzyme-linked immunonsorbent assay methods, plasma TNF- , IL-1 and IL-10 levels were measured on day 1, 3 and 7. Subjects were monitored prospectively to determine mortality rate. The plasma cytokine levels werepresented as means and standard deviations. One-way ANOVA test was performed if equal variances assumed, Games-Howe11 test was performed if equal variances not assumed.Results:The at risk and ALI/ARDS populations were matched f-or age, sex, APACHE II score on admission and ICU mortality. On day 1, 3 of ALI/ARDS, plasma IL-1 and IL-10 concentrations were higher than which of at risk. The ratio of TNF-a/IL-10 was lower of ALI/ARDS on day 1 than of at risk. Nonsurvivors of ALI/ARDS had higher and persistent plasma TNF-,IL~l and TNF-,IL- concentrations than which of survivors, thou gh the significance was not statistically The median IL-10 concentrations in the plasma of ALI/ARDS were higer than which of at risk at early stage. The ratio of TNF-/IL-10 wasdecreased on day 1 with nonsurvivors of ALI/ARDS, then rosegradually.Discussion and Conclusions:Our findings indicated that an initial, exaggerated both inflammatory and anti-inflammatory respons is presented in ALI/ARDS Stronger anti-inflammatory effects maybe ocurred at the onset of ALI/ARDS than that of at risk. Such intensive inflammatory and anti-imflammmatory response might declined over time in both ALI/ARDS and at risk. Higher elevation of pro-immflammatory cytokines-TNF-, IL-l and anti-inflammatory cytokines - IL-1 concentrations suggested but not proved poor outcome in ALI/ARDS. It suggested that favorab-le outcome in ALI/ARDS is associated withthe balance between pro-inflammatory and anti-inflammatory mediators. It is sugge-sted but not proved that unfavorable outcome in ALI/ARDS is associated with an persistent elevation of plasma pro-immflammatory cytonkines concentrations TNF- and IL-l.