Systemic cytokine levels in community-acquired pneumonia and their association with disease severity

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Abstract
Pro-inflammatory and anti-inflammatory cytokines are important mediators in the host response to infection. In contrast to the pro-inflammatory cytokines little is known about anti-inflammatory cytokines in community-acquired pneumonia (CAP) and their relation to disease severity.Circulating levels of three pro-inflammatory cytokines (interleukin (IL)-1β, IL-6 and tumour necrosis factor (TNF)-α) and two anti-inflammatory cytokines (IL-10, IL-1 receptor antagonist (IL-1ra)) were measured using an enzyme immunoassay on admission, day 3 and day 5 in 24 patients with CAP. The modified British Thoracic Society (BTS) prognostic rule and Acute Physiology and Chronic Health Evaluation (APACHE) II score were used to assess disease severity.IL-6, TNF-α, IL-10 and IL-1ra concentrations were detected in most patients on admission and decreased significantly on day 3 and day 5 in all survivors. A significant difference between the BTS high-risk and low-risk groups was only found for IL-6 (median (range) 477 pg·mL−1(7.6–1402 pg·mL−1)versus81.6 pg·mL−1(0–943 pg·mL−1); p<0.05). IL-6 also correlated with the APACHE II scores on admission.Concentrations of anti-inflammatory cytokines were elevated on admission in community-acquired pneumonia but they did not correlate with disease severity scores.