Monocyte Tumor Necrosis Factor Receptor Levels as a Predictor of Risk in Human Sepsis

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Abstract
Objective: To assess peripheral blood monocyte tumor necrosis factor receptor (TNFR) levels and plasma soluble tumor necrosis factor receptor (sTNFR) concentrations in critically ill patients with sepsis syndrome. Design: Prospective, descriptive cohort study with no interventions. Setting: Surgical intensive care unit of a tertiary-care hospital associated with a university medical school. Patients: Twenty-one patients with a documented source of infection who met currently accepted criteria for sepsis syndrome/septic shock. Main Outcome Measures: Plasma sTNFR p55 and p75 values were quantified by enzyme-linked immunosorbent assay, and monocyte TNFR levels were assessed by fluorescence flow cytometry after the monocytes were stained with biotinylated human recombinant TNF-α and streptavidin-phycoerythrin. Results: Compared with healthy controls, plasma sTNFR p55 and p75 values were significantly higher (P<.01) in both surviving and nonsurviving patients with sepsis; in nonsurviving patients with sepsis, however, only sTNFR p55 values were significantly (P<.05) higher than in surviving patients with sepsis. By contrast, monocytes from the nonsurviving patients with sepsis manifested a significant (P<.01) and sustained (up to 4 days) decrease in cell surface TNFR values compared with either the normal controls or the surviving patients with sepsis. Conclusions: Assessment of monocyte surface TNFR values may provide a rapid prognostic indicator for patients with sepsis who are at increased risk of death. (Arch Surg. 1996;131:434-437)