| ObjectiveTo test the level of interleukin (IL) 18 and 10 in the early stage of sepsis. To evaluate the values of serum IL-18 and 10 in the severity and prognosis of sepsis.MethodsThis study was a prospective randomized controlled trial, selected thirty-eight patients with spesis erolled in the intensive care unit of our hospital as sepsis group. Twenty patients with non imflamatory disease were control group. The therapy efficacy was classified to survival or death according to 28-days survival after group admission. The baseline data (vital signs) and laboratory examinations (blood routine, hepatic function, renal function, electrolyte, blood cloting function, blood gas analysis, C reactive protein, lactate) were recorded at 24h,48h,72h after patients admission. And APACHEⅡ, SOFA scores were calculated respectively. At the same time obtained 3ml venous blood, and the IL-18, IL-10 levels were tested by ELISA, the IL-18/IL-10 ratio were calculated.Results There were 546 patients erolled in ICU during research,210 developed sepsis, 38 patients were selected as sepsis group,20 patients with noninflamatory disease were control group. The comparison between two groups of baseline data and laboratory examination were no significant differences (P>0.05).The level of serum IL-18 in sepsis group at 24h,48h,72h were all higher than control group (respectively 103.08±20.77 vs 31.84±14.29,94.53±21.54 vs 32.51±16.21,86.81±20.08 vs 32.16±16.32, all P<0.05), and serum IL-18 was downtrend in sepsis group, the difference had statistical significance (P<0.05). The serum IL-18 level in death patients with sepsis were higher than survivals at 24h,48, 72h, the difference had statistical significance (respectively 108.36±18.54 vs 91.66±21.49,92.13±28.92 vs 54.16±31.76,91.78±17.33 vs 76.04±22.09, all P<0.05). The level of IL-18 in patients with septic shock were higher than non shock ones at 24h,48h,72h (respectively 120.27±17.12 vs 95.15±17.39,111.01±19.57 vs 86.92±18.10,102.69±17.72 vs 79.48±16.77,all P<0.05).The level of serum IL-10 in sepsis group was higher than control group at 24h, 48h,72h (respectively 92.40±15.33 vs 55.79±13.12,100.88±14.99 vs 56.66±11.81,112.74±14.76 vs 57.49±11.48, all P<0.05), and IL-10 was uptrend in sepsis group, the difference had statistical significance (P<0.05). The serum IL-10 in death patients with sepsis were higher than survivals at 24h,48,72h, the difference had statistical significance (respectively 99.42±12.10 vs 77.20±9.47,103.39±17.24 vs 67.88±18.90,118.99±11.20 vs 99.20±12.46, all P<0.05), and the levels were all uptrend in both groups. The serum IL-10 in patients with septic shock were higher than non shock ones at 24h,48h,72h (respectively 100.42±11.54 vs 88.70±15.62, 108.64±10.99 vs 97.30±15.41,119.82±9.66 vs 109.74±15.69, all P<0.05), and IL-10 were all uptrend in both groups.The comparison of APACHEⅡsocre between sepsis group and control group was not significant difference, while SOFA score, CRP and lactate were all conversely. APACHEⅡ,SOFA, CRP and lactate in death group of sepsis patients were all higher than survival group, the difference has statistical significace. However, the difference between shock and nonshock groups was no significantly. These results suggeted that IL-18 and 10 were more sensitivity reflecting the progress and prognosis of sepsis.The ratio of IL-18/IL-10 in sepsis group was higher than control group at 24h, 48h,72h (P<0.05), the levels were downtrend in sepsis group (P<0.05), but no changing in control group (P>0.05). The comparison of the ratio of IL-18/IL-10 between death patients with sepsis and survivals at 24h,48,72h, the difference were no significant difference (P<0.05), but the ratios were all downtrend in both groups. The comparison of the ratio of IL-18/IL-10 between patients with septic shock and non shock ones at 24h,48,72h, the difference were no significant difference (P<0.05), and the ratios were all downtrend in both groups.The levels of serum IL-18 in sepsis group were related with IL-10 at 24h,48h, 72h (pearson correlation were respectively 0.406,0.360,0.360, P<0.05). The levels of IL-10 in sepsis patients were related with IL-18, CRP (pearson correlation were respectively 0.575,0.562,0.500, P<0.05), SOFA (pearson correlation were respectively 0.339,0.405,0.446, P<0.05) at 24h,48h,72h.The reciver operating characteristic (ROC) curve about IL-18, IL-10, CRP, lactate, APACHEⅡ,SOFA score at 24h in sepsis were respectively 0.718 [95%CI (0.532-0.903)],0.929 [95%CI (0.843-1.016)].0.939 [95%CI (0.866-1.012)],0.793 [95%CI (0.637-0.950)],0.715 [95%CI (0.529-0.901)],0.827 [95%CI (0.678-0.976)], all P<0.05. At 48h were respectively 0.708 [95%CI (0.511-0.906)],0.929 [95%CI (0.841-1.018)],0.933 [95%CI (0.855-1.010)],0.798 [95%CI (0.643-0.953)],0.686 [95%CI (0.484-0.887), P>0.05],0.785 [95%CI (0.616-0.954)], all P<0.05. At 72h were 0.686 [95%CI (0.480-0.892), P>0.05],0.859 [95%CI (0.714-1.004)],0.929 [95%CI (0.849-1.010)].0.793 [95%CI (0.640-0.947)].0.713 [95%CI (0.525-0.901)]. 0.813 [95%CI (0.662-0.963)], all P0.05.ConclusionsThe levels of serum IL-18 and 10 were all elevated in the early stage of sepsis, and the levels in sepsis group were higher than control group, death patients were higher than survival ones, septic shock higher than non shock ones. Serum IL18 and 10 were more sensitivity than APACHEⅡ,SOFA, CRP and lactate in reflecting the progress and prognosis of sepsis. The specificity of IL-10 in reflecting prognosis of sepsis was the best one. The value of IL-18 in prognosis of sepsis was higher than APACHEⅡscore. The levels of IL-18 and 10 may evaluate the severity of sepsis and prognosis. |
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