Plasma Tumor Necrosis Factor in Patients with Septic Shock: Mortality Rate, Incidence of Adult Respiratory Distress Syndrome, and Effects of Methylprednisolone Administration

TLDR

Serial plasma samples from 86 septic shock patients in a randomized trial of methylprednisolone were assayed for tumor necrosis factor by ELISA. TNF was detected in 27 of 74 septic shock patients (but only 1 of 12 non‑septic shock patients), with equal frequency in gram‑negative and gram‑positive sepsis; levels peaked at admission and fell over 24 h regardless of methylprednisolone, and patients with detectable TNF had higher incidence and severity of ARDS and higher mortality.

Abstract

We assayed serial plasma samples from 86 patients, who were enrolled in a prospective randomized trial of the effects of methylprednisolone (MPSS) in septic shock, for the presence of cytokine tumor necrosis factor (TNF) using an enzyme-linked immunosorbent assay. TNF was present in the plasma of 27 of the 74 patients with septic shock, but in only 1 of the 12 patiente with shock due to other causes. TNF was detected with equal frequency in patiente with shock from gram-negative or from gram-positive bacillary sepsis. TNF levels were highest on the initial sample and decreased significantly over the subsequent 24 h in both the patiente treated with MPSS and in those given placebo. Patiente with detectable TNF had a higher incidence and severity of the adult respiratory distress syndrome and a higher mortality rate than did patiente without detectable TNF.