|Costa Vaz, Flavio|
Submitted to: Pediatric Research
Publication Type: Abstract Only
Publication Acceptance Date: 3/1/2005
Publication Date: 5/1/2005
Citation: Delgado, A.F., Leone, C., Okay, T.S., Nichols, B.L., Feferbaum, R., Costa Vaz, F.A. 2005. "Silent" tumor necrosis factor alpha (TNF alpha) and interleukin 6 (il-6) serum elevations in critically ill malnourished children do not correlate with therapeutic intervention scoring system (TISS) at 10 days recovery [abstract]. Pediatric Academic Society Meeting. Pediatric Academic Society 57:Abstract 2428. 2005 CDROM. Interpretive Summary: Interpretive Summary not needed for this 115.
Technical Abstract: BACKGROUND: Malnourished children (Mn) often fail to display classical symptoms of infection and inflammatory response. Cytokines are major mediators of the inflammatory cascade. Serum Levels of TNF alpha and IL-6 can reflect intensity of Systemic Inflammatory Response Syndrome (SIRS). Hypothesis: Mn admitted with SIRS produce higher but more "silent" levels of cytokines than well nourished (Wn) and have greater risk of death or persistent inflammation. OBJECTIVE: Determine if nutritional status and serum TNF alpha and IL-6 levels correlate with clinical outcome of Mn children with SIRS. DESIGN/METHODS: In a case control study, 15 Mn and 14 Wn admitted with SIRS were investigated, after hemodynamic stabilization, on days (D) 1, 5 and 10. All received parenteral and/or enteral nutrition with standardized calories and proteins. Serum TNF alpha and IL-6 were measured with ELISA assays (R & D Systems, Abington, UK). TISS was utilized to evaluate severity of illness. RESULTS: 4 Mn and one Wn died. Mean (+/- SD) Z-scores for Mn weight/age (-3.1 +/- 1.9) and weight/height (-1.4 +/- 2.3) and Wn (0.2 +/- 0.9) and (1.1 +/- 1.5) on D1. IL-6 was 181 +/- 298 pg/ml and TNF alpha 22 +/- 37 pg/ml for Mn, 124 +/- 17 for IL-6 and 13 +/- 13 for TNF alpha for Wn on D1. Mean TISS was 30.5, 12.4 and 8.3 for Mn and 29.2, 14.6 and 8.5 for Wn on D1, 5 and 10 with no significant difference. There was significant correlation between TNF alpha and TISS in both groups. There was a decline of TNF alpha only in Wn patients on D10 (p<0.05) and of IL-6 for Wn and Mn on D10 (p<0.05). CONCLUSIONS: Nutritional status was different between the Mn and Wn. Both groups had identical severity of symptoms and levels of cytokines on D1. Serum TNF alpha correlated with severity of illness by TISS in both groups on D 1. There was significant decline on D10 of IL-6 in Wn and Mn but of TNF alpha only in Wn (p<0.05). In Mn, serum TNF alpha responded appropriately on D 1, but Mn had persistent elevations of TNF alpha on D 10. Mn thus increased duration of the TNF alpha inflammatory response beyond D 10 that was not detected by TISS. "Silent" TNF alpha inflammatory response during recovery may have contributed to the greater mortality in severely ill Mn.