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Intensive Care Medicine

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01-12-2016 | Original

Plasma cytokine levels predict response to corticosteroids in septic shock

Authors: Peter Bentzer, Chris Fjell, Keith R. Walley, John Boyd, James A. Russell

Published in: Intensive Care Medicine | Issue 12/2016

Abstract

Purpose

To investigate if plasma cytokine concentrations predict a beneficial response to corticosteroid treatment in septic shock patients.

Methods

A cohort of septic shock patients in whom a panel of 39 cytokines had been measured at baseline (n = 363) was included. Patients who received corticosteroids were propensity score matched to non-corticosteroid-treated patients. An optimal threshold to identify responders to corticosteroid treatment for each cytokine was defined as the concentration above which the odds ratio for 28-day survival between corticosteroid- and non-corticosteroid-treated patients was highest.

Results

Propensity score matching partitioned 165 patients into 61 sets; each set contained matched corticosteroid- and non-corticosteroid-treated patients. For 13 plasma cytokines threshold concentrations were found where the odds ratio for survival between corticosteroid- and non-corticosteroid-treated patients was significant (P < 0.05). CD40 ligand was associated with the highest odds ratio and identified 21 % of the patients in the propensity score matched cohort as responders to corticosteroid treatment. Combinations of triplets of cytokines with a significant odds ratio, using the thresholds identified above, were tested to find a higher proportion of responders. IL3, IL6, and CCL4 identified 50 % of the patients in the propensity score matched cohort as responders to corticosteroid treatment. The odds ratio for 28-day survival was 19 (95 % CI 3.5–140, P = 0.02) with a concentration above threshold for a least one of these cytokines.

Conclusion

Plasma concentration of selected cytokines is a potential predictive biomarker to identify septic shock patients that may benefit from treatment with corticosteroids.

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Title: Plasma cytokine levels predict response to corticosteroids in septic shock
Authors: Peter Bentzer
Chris Fjell
Keith R. Walley
John Boyd
James A. Russell
Publication date: 01-12-2016
Publisher: Springer Berlin Heidelberg
Published in: Intensive Care Medicine / Issue 12/2016
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-016-4338-z

At a glance: The STEP trials

Springer Medicine

Plasma cytokine levels predict response to corticosteroids in septic shock

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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