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High cytokine levels at admission are associated with fatal outcome in patients with necrotizing fasciitis Volume 15, numéro 2, June 2004

Auteurs
University of Colorado, Health Sciences Center, Denver, CO, Department of Emergency Medicine, Highland General Hospital, Oakland, CA Abteilung fr Klinische Pharmakologie, Klinikum der Ludwig‐Maximilians‐Universität Munich, Germany

We evaluated in a blinded fashion the cytokine profiles of patients with suspected necrotizing fasciitis. In 15 out of 20 patients, the diagnosis of necrotizing fasciitis was established; five patients had cellulitis. Eighteen of the 20 patients were i.v. drug users. Five of the 15 patients with necrotizing fasciitis died (33%). On admission, serum levels for interleukin‐1β (IL‐1β), IL‐1‐receptor antagonist (IL‐1Ra), IL‐18 and interferon‐γ (IFNγ) as well as white blood cells (WBC) were significantly elevated in patients with fatal outcome compared to survivors with necrotizing fasciitis. IL‐1Ra and WBC levels were also higher than in patients with cellulitis. No differences were observed between patients groups for IL‐6 and IL‐8. In summary, significantly elevated levels of proinflammatory cytokines and particularly IL‐1Ra are associated with fatal outcome in patients with necrotizing fasciitis. The measurement of proinflammatory cytokines and IL‐1Ra may help to establish early diagnosis of life‐threatening necrotizing fasciitis and thus to initiate aggressive treatment.